BusinessIQ

General Information

^*Amount Requested
$

^*Existing customer?
Yes No

Sales Rep Name (if known)

Your Caterpillar Dealer

Type of Credit Requested

Dealer Code: E250

Company Information (Photo copy of current Driver License required on all applicant(s) other than Corporation).

^*Business Name

Doing Business As (DBA Name)

Tax ID

^*Physical Address

^*City

^*State/ Province

^*Zip/Postal

Country

Billing Address

City

State/ Province

Zip/Postal

Country

Telephone - Work

Email Address

^*Legal Structure

SIC Code

^*Are you Tax Exempt?
Yes No

Number of Employees

Year Business Established

^*Application Contact Name

Telephone - Work

^*Application Contact Email Address

Do You Require A Purchase Order?
Yes No

Industry

Trade Reference Information

Reference Name

Phone Number

Contact Name

Contact Email

Reference Name

Phone Number

Contact Name

Contact Email

Bank Reference Information (Additional financial information may be requested and is required for credit over $200,000)

Bank Name

Bank Account Number

Bank Account Type

Bank Account Balance
$

Bank Contact Phone Number

Company Financials

Income Statement

Gross Profit (Net Sales - Cost of Sales)

NET INCOME (Gross Profit - All Expenses)

Balance Sheet

Assets

TOTAL ASSETS

Liabilities

Long-Term Debt

TOTAL LIABILITIES

TOTAL EQUITY

Principle/Guarantor (If you are a sole proprietor or an individual doing business under a trade name; provide your full home address)

Principal Title

Principal First Name

Principal Middle Name

Principal Last Name

Principal Home Address

City

State/ Province

Zip/Postal

Telephone - Home

Telephone - Work

Telephone - Cell

Principal Email Address

Principal Social Security Number (SSN)

Principal Date of Birth

Principal's Annual Income
$

Principal Ownership %
%

Principal Title

Principal First Name

Principal Middle Name

Principal Last Name

Principal Home Address

City

State/ Province

Zip/Postal

Telephone - Home

Telephone - Work

Telephone - Cell

Principal Email Address

Principal Social Security Number (SSN)

Principal Date of Birth

Principal's Annual Income
$

Principal Ownership %
%

^*Personal Guarantee Authorization (Y/N)
Yes No

Personal Guarantee

NOTICE AND CONSENT: By providing the information above and signing below, Applicant is requesting the extension of credit from Wagner Equipment Co. and/or Wagner Rents Inc. hereinafter referred to as "Wagner" and/or Caterpillar Financial Services Corporation (“CFSC”) or Caterpillar Financial Commercial Account (”CFCA”) [all of the above entities (except for Wagner Equipment Co. & Wagner Rents Inc. collectively, the “Caterpillar Companies”], and Applicant agrees that the above information may be shared between and among Wagner and the Caterpillar Companies and used to process your applications for credit and other orders, assist with collection efforts, and to improve or market Caterpillar products or services. Applicant and each person signing below warrants and represents that all of the information and documents provided to Wagner or the Caterpillar Companies in connection with the request for credit including the information above shall be true, correct, accurate and complete and have been provided for the purpose of obtaining business credit from Wagner and/or one or both of the Caterpillar Companies. Applicant authorizes Wagner and the Caterpillar Companies to obtain credit experience information and opinions as to credit worthiness from banks, credit bureaus, creditors, references, and from Applicant including, but not limited to, balance sheets, cash flow statements, and income statements. Applicant authorizes the release of any of such information to and the use by Wagner and the Caterpillar Companies. Each of Wagner and the Caterpillar Companies reserves the right to refuse credit, services and charges at any time. Applicant agrees to and expressly acknowledges that Applicant has read and fully understands the terms and conditions contained on the second page of this Application, the “Open Account Agreement Between Applicant/Buyer and Caterpillar Dealer/Seller.” Applicant understands and agrees to be bound by all terms and conditions currently found, and as may be amended and updated, that may be downloaded at https://wagnerequipment.com such terms and conditions are incorporated by reference as if fully stated herein and may be updated or amended in the normal course of business.

PRINT AGREEMENT

^*Signature Of Guarantor

^*Title

^*Date

KNOW ALL MEN THESE PRESENTS, That I, we, and each of us, stockholders, directors, managers, officers or otherwise interested in ________________________________ hereinafter referred to as "Debtor" do hereby request Wagner Equipment Co. and/or Wagner Rents, Inc. hereinafter referred to as "Wagner"extend credit to or otherwise do business with said Debtor or renew or extend any obligation of or forbear for any period of time the strict enforcement of any obligation to the above-named Debtor. To induce Wagner to do so, and for good consideration and benefits to accrue to each of therefrom, each of us as primary obligor, jointly and severally, unconditionally guarantees to Wagner that Debtor will fully, promptly and faithfully perform, pay and discharge all of Debtors present and future obligations to Wagner, and agrees without Wagner first having to proceed against said Debtor of liquidate any evidence of indebtedness or security therefore to pay Wagner on demand all sums due and to become due to Wagner from said Debtor, including default interest at 21%,costs,attorney fees, or other expenses which Wagner may incur by reason of Debtors default. Each of the undersigned hereby subordinates any sums now or hereafter due to him from Debtor to the payment of any sums now or hereafter due Wagner from Debtor. This Guaranty may be terminated only by a written termination agreement signed by Wagner Equipment and the terminating guarantor; but shall continue thereafter as to each of us who has not entered into such termination agreement,and the guarantee shall continue with respect to any transaction with and any obligation of the Debtor incurred prior to date of termination. Death shall not terminate the guarantee of any obligation due and owing by Debtor as of the date of death of any guarantor. Each of us waives notice of the acceptance hereof and or presentment,demand, protest,and notice of non-payment or protest as to any note or obligation signed, accepted, endorsed, or assigned by Debtor to Wagner. Renewal, extension or transfer of any obligations of Debtor or the making of partial payments thereon or settlements, releases, or compromises or liquidation of any obligations or security therefore shall not affect the obligation of any of us hereunder. Agreement that for purposes of determining venue for bringing any legal action on the account, that the account is payable at Wagner Equipment Co. at 18000 Smith Road, Aurora, Colorado 80011 and any such action may be brought in Adams County, CO. Albuquerque, NM, or El Paso TX at the election of Wagner Equipment Co. and or Wagner Rents Inc. This Guaranty shall bind our respective heirs, administrators, personal representatives , successors, and assigns. All rights of Wagner shall be considered as cumulative

Attachments

Please attach documents relevant to the application decision process (i.e., company financials, relevant license information, etc)

Attachment Description

Attachment Location

Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.