Credit Application

33%

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Amount Requested*

Business Name
Date Incorporated
Date Format: DD slash MM slash YYYY
Social Security Number or EIN*
Date of Birth*
Bank Name*
Bank Branch Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Contact
First Last
Bank Phone Number

Trade Referneces
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Authorization*
- • By checking you acknowledge that you are authorized to sign on behalf of this business and you give Legion Digital permission to submitt your information to various finance companies for credit.