If you are a licensed Home Improvement Contractor and would like to learn more about Viking Capital's unique financing partnerships, please PRINT this form and FAX the completed application to: Viking Capital, Inc. Home Improvement Division - FAX: 877-945-1807. Please provide the following ownership information:
Business Name Owner's Name Title SSN Owner's Name Title SSN Owner's Name Title SSN
Please indicate your type of business: Corporation Partnership Sole Proprietorship Other
Please provide the following contact information:
Street Address City State Zip Email Address:
Web
Work Phone
Fax
Cell Phone
How many years have you been in business? Contractor License Number:
Approximate Annual Sales: $ Number of projects completed last year:
Number of projects estimated for this year: What is your average project size ($)? $
Do you currently offer financing? Yes No How many projects do you finance per year?
What finance company do you currently work with?
Please describe your financing needs and provide any information that will help Viking Capital assist you.
I authorize Viking Capital, Inc. to obtain my personal credit information from credit reporting agencies and other sources for verification of the information shown with the understanding that this information is for the sole use of Viking Capital and not to be shared.
Signed Date:
Copyright © 2005 [Viking Capital, Inc.]. All rights reserved. Revised: July 24, 2007