New Dealer Form - Pure Finance Group

Interested in financing services for your contracting business?

Be prepared to provide the following information before starting this form:

Owner(s) Name
1. Ownership Structure %
Primary Owners Email (for contract purposes)
Primary Owners Phone
Tax ID # (IEN/TIN/FIEN)

Please be advised that additional documentation may be required based on qualification including a copy of business general liability insurance declaration page, checking account statement, personal address of primary owner, and business references

Dealer Form

Please complete the form below.

Legal Name Of Company *
DBA/Trade Name
Website
Company Structure *
State of Incorporation *
Business Address *
Number of Employees *
Tax ID # (IEN/TIN/FIEN) *

Owner's First and Last Name *
Ownership % *
Primary Owner's Email *
Primary Owner's Phone *
Annual Revenue *
Would you like to receive a complimentary evaluation of your current credit card processing fees? (Savings can range from 10%-100%) Yes

Personal Address of Primary Owner *
Checking Account Type *
Checking Statement
Business Reference 1
Business Name *
Phone *
Business Reference 2
Business Name *
Phone *

Year Of Incorporation *

Personal Address of Primary Owner *
Checking Account Type *
Checking Statement
Business Reference 1
Business Name *
Phone *
Business Reference 2
Business Name *
Phone *

Current Business Insurance Declaration Page Upload

By checking this box, you attest that all information submitted on this form is true and correct and you authorize Pure Finance Group LLC (Lender) and its designated agents and representatives to conduct a review of Contractor by conducting a review of business and consumer reports, make inquiries to associations and references it deems necessary without further notice to obtain credit information to complete an initial background check considered necessary by Lender. We maintain the authority to decline your application based on our own discretion, and you agree to these terms. You authorize Pure to send a contract agreement to the email of the primary owner you have entered above. This contract agreement will function as a formal documentation of our partnership. If we do not approve your application, this contract is made null and void.

Become A Dealer

Dealer Form

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