Apply Here For Credit Financing With
American Mortuary Coolers & Equipment

Fill out the online form below or print out the pdf version (->) and fax to 800-987-2430 or email to cool@mymortuarycooler.com.

If you have any questions, click to chat below or call us at 1-888-792-9315.

Business Information

Complete Legal Name of Business *

Value is required

Doing Business As (DBA) Name (if applicable)

Number Of Calls Per Year *

Value is required

Business Start Date *

Value is required

Number Of Employees *

Value is required

Date Of Current Ownership *

Value is required

Annual Revenue *

Value is required

Federal Tax ID *

Value is required

Billing Address

Value is required

Equipment Address (if different than billing)

Contact

Phone Number *

Value is required

Cell Number

WEF Customer Number

Fax Number

1st Principal Owner's Information

(All fields required for all business structures except Municipal and Non-Profit)

First Name *

Value is required

Middle Initial *

Value is required

SSN *

Value is required

% Owned *

Value is required

Last Name *

Value is required

Suffix (ex: Jr, Sr, II, III)

Date of Birth *

Value is required

Primary Phone Number *

Value is required

Title *

Value is required

Address Line *

Value is required

Apartment/Suite #

Value is required

2nd Principal Owner's Information

(All fields required for all business structures except Municipal and Non-Profit)

First Name *

Middle Initial *

SSN *

% Owned *

Last Name *

Suffix (ex: Jr, Sr, II, III)

Date of Birth *

Primary Phone Number *

Title *

Apartment/Suite #

Bank Reference

Bank Name

City

Contact

State

Phone Number

Equipment Information

Vendor Name

Requested Term (in months)

Phone Number

Contact

Type of Equipment *

Value is required

Description *

Value is required

Equipment Cost *

Value is required

Amount Owed on Trade In *

Value is required

Amount of Trade In *

Value is required

Cash Down Payment *

Value is required

Ammount of Financing Needed *

Value is required

Insurance Company

(that will insure above equipment)

INSURANCE IS REQUIRED ON ALL EQUIPMENT FINANCED

Agent Name

Phone Number

Company Name

Policy Number

Terms & Conditions

The information provided in this application shall be kept confidential and will not be shared with anyone else.

For purposes of obtaining credit, I (We) certify that all of the information in this application is true and correct. I (We) authorize Western Equipment Finance, Inc. (Western) to confirm all information in this application (which may include obtaining credit reports, contacting references, etc.) either in connection with my (our) initial application for credit, or at any time during the term of the lease/finance agreement. I (We) agree to release and waive all claims against Western and those references listed above for all acts or omissions that occur in verifying the same information. Customer Identification Program: To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license and other identifying documents.

Value is required

E-Signature of 1st Principle Owner *

Value is required

Title *

Value is required

Date *

Value is required

E-Signature of 2nd Principle Owner

Title

Date

Thank you!

Apply Here For Credit Financing With American Mortuary Coolers & Equipment

Business Information

Billing Address

Equipment Address (if different than billing)

1st Principal Owner's Information

(All fields required for all business structures except Municipal and Non-Profit)

2nd Principal Owner's Information

(All fields required for all business structures except Municipal and Non-Profit)

Bank Reference

Equipment Information

Insurance Company

(that will insure above equipment)

INSURANCE IS REQUIRED ON ALL EQUIPMENT FINANCED

Terms & Conditions

The information provided in this application shall be kept confidential and will not be shared with anyone else.

Apply Here For Credit Financing With
American Mortuary Coolers & Equipment