Community Home Financial Services

Dealer Application....

To apply to become a dealer for Community Home Financial Services, please complete the form below. When you submit the form, an application form will be filled out for you to print. Please print this form and mail it, along with your financial statement and a description of guaranty or warranty given to customers, to Community Home Financial Services, 234 East Capital Street, Jackson, MS 39201.

Date:
Phone:
Business Legal Name:
Fax:
Business Address:
City
State	Zip
	for years
County of Business:
Email:
Cellphone:

Previous Address:
City:
State:	Zip
	for years

Dealer License #:
Type of License:
Type of Business:
Date Established:
Ownership

Principals:
Principal Name:
Title:
Social Security Number:
Home Address:
City:
State:	Zip

Alt. Principal Name:
Title:
Social Security Number:
Home Address:
City:
State:	Zip

Alt. Principal Name:
Title:
Social Security Number:
Home Address:
City:
State:	Zip

Trade References:	(Name suppliers of major products financed)
1. Name:
Phone:
Contact Name:
Address:
City:
State:	Zip

2. Name:
Phone:
Contact Name:
Address:
City:
State:	Zip

3. Name:
Phone:
Contact Name:
Address:
City:
State:	Zip

Bank of Deposit:
Contact Person:
Account Number:

Have Financed Paper with:
Name:
Phone:
Address:
City:
State:	Zip
Contact:

2. Name:
Phone:
Address:
City:
State:	Zip
Contact:

3. Name:
Phone:
Address:
City:
State:	Zip
Contact:

Annual Volume of Paper Financed: $
Average Size Transaction:
Such paper as we may submit to you for purchase will represent bona fide obligations due us from our cutomers to whome sales of merchandise and/or services have been completed on a time payment basis in the normal conduct of our business.

Firm:
Name:
Title:


Sir/Madam:
In connection with our dealer application and as an inducement for you to approve this application, the undersigened hereby answers the following questions:

1. Has our Company or any of its officers or stockholders (owner) ever been listed on the Federal Housing Administration's black list or precautionary list?
	Yes No
If yes, explain:

2. Is our Company or any of its officers or stockholders (owner) presently under indictment or ever been convicted of a felony?
	Yes No
If yes, explain:

3. Is our Company or any of its officers or stockholders (owners) presently charged with or ever been convicted of violating any law relating to the business of our Company which violation constitutes a misdemaeanor?
	Yes No
If yes, explain:

4. Is our Company presently under investigation or has it in the last five years been investigated by any federal, state or local governmental body for possible violation of law in the conduct of the business of our Company?
	Yes No
If yes, explain:

5. Has our contractor's license ever been revoked or suspended in the last five years?
	Yes No
If yes, explain:

6. Has our company ever been charged with an unfair or deceptive practice by the United States Federal Trade Commission or is there presently any investigation of our business activities by that Commision?
	Yes No
If yes, explain:

Name of Contractor:

When you submit the form, an application form will be filled out for you to print. Please print this form and mail it, along with your financial statement and a description of guaranty or warranty given to customers, to Community Home Financial Services, 234 East Capital Street, Jackson, MS 39201.

Community Home Financial Services, Inc.
234 EAST CAPITOL STREET
JACKSON MS 39201-2410
PH: 601-923-1992
FAX 601-923-1938
TOLL FREE
PH: 888-236-1992
FAX: 888-841-1938
info@CHFonline.com

Retail Home Improvement Contract Financing
Manufacturing and Supplier Programs Available
One Stop Shopping for A-B-C Grade Loans
Financing available in 21 States Loans from $3,000.00 - $35,000.00
No FICO Score required
A-B-C Grade Loans
Fixed Rates and Flexible Terms
Debt Ratios up to 50% on gross income
Online Document Preparation
Secured and Unsecured Paper available
Three hour Approval