Dealer Application – EGIA Step 1 of 3 33% Company InformationCompany Name* Doing Business As (DBA) Business Structure* Corporation Limited Liability Company Sole Proprietorship Partnership Year Company Started* Company Phone*Company Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Company Email* Additional Email Company Website States You Do Business In***HOLD CONTROL TO MULI-SELECT** Documentation of business licenses/registrations, contractor’s licenses or professional registrations are required for ALL STATES you intend to do financed business in. NOTE: Some states require businesses that offer financing to be registered with them. FFC requires proof of this registration prior to funding the first approved loan.AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificEmail to Receive Credit Decisions* Additional Email to Receive Credit Decisions Primary Contact Person* First Last Title* Owner InformationOwner 1 Name* First Last Owner 1: Personal Phone Number*Owner 1: % Owned* Owner 1: Home Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Owner 1: SSN* Owner 2 Name First Last Owner 2: Personal Phone NumberOwner 2: % Owned Owner 2: Home Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Owner 2: SSN Licensing & Product InformationWhat Products Do You Sell/Install***HOLD CONTROL TO MULTI-SELECT**Basement FinishingBasement WaterproofingBathroom RemodelBlinds/ShadesCement/ConcreteDog FencesDoorsElectricalFencesFireplaces/Chimneys/StovesFlooringFoundationGarage/Storage/Sheds/BuildingsGuttersHVACInsulationKitchen RemodelLandscapingMold RemediationOutdoor LightingPaintPatios/DecksPlumbingPools/SpasRoofingRoom AdditionsShelvingSidingSolar/Energy EfficiencyStairlifts/MobilityWalk-in Tubs/ShowersWater TreatmentWindowsOTHERWhat Other Products Do You Sell/Install* Does Your Company Install the Products Sold if They Require Installation?* Yes No Who Installs Your Products?* List the Manufacturer(s) of the Product(s)*License Number License Number Financing InformationThis information is for our records only. It does not affect the approval of this application.Current Finance Programs (List Companies)*Average Sales Price* Total Number of Sales Per Month* Number of Financed Sales Per Month*Please enter a number greater than or equal to 0.Owner Signature & ACH AgreementAgreement*By checking this box, I agree that for the purpose of establishing and maintaining a dealer relationship with Foundation Finance Company (FFC), I hereby authorize FFC to make all investigations deemed necessary, including obtaining a credit report on any owner or principal of the dealership. Any reference listed on this application is authorized to release information about my company’s experience with them. FFC promises not to divulge any information contained herein. This information is for internal use only to establish financial soundness and credit worthiness of dealer principals. I am authorized to provide this information on behalf of dealership. I authorize Foundation Finance Company to initiate credit entries and to initiate debit entries and adjustments for any entries in error to the bank account provided them. I agree Owner Name* First Last AgreementBy checking this box, I agree that for the purpose of establishing and maintaining a dealer relationship with Foundation Finance Company (FFC), I hereby authorize FFC to make all investigations deemed necessary, including obtaining a credit report on any owner or principal of the dealership. Any reference listed on this application is authorized to release information about my company’s experience with them. FFC promises not to divulge any information contained herein. This information is for internal use only to establish financial soundness and credit worthiness of dealer principals. I am authorized to provide this information on behalf of dealership. I authorize Foundation Finance Company to initiate credit entries and to initiate debit entries and adjustments for any entries in error to the bank account provided them. I agree Owner 2 Name First Last Dealer Document UploadNow that you've completed your application, there are a number of documents FFC needs to complete the processing of your application. Click here to download the Foundation Finance Master Dealer Agreement.What documents do you need to upload? Foundation Finance Master Dealer Agreement Voided Business Check Business License/Registration Contractor's/Installer's License Business Liability Insurance/Bonding Foundation Finance Master Dealer Agreement Drop files here or Select files Max. file size: 50 MB, Max. files: 8. Voided Business Check Drop files here or Select files Max. file size: 50 MB, Max. files: 8. Business License/Registration Drop files here or Select files Max. file size: 50 MB, Max. files: 10. Contractor's/Installer's LicenseMax. file size: 50 MB.Business Liability Insurance/Bonding Drop files here or Select files Max. file size: 50 MB, Max. files: 10.
