javasupply.com
Hot New Products
Coffee
Concession Trailers
Equipment
Syrups
Contact
Taylor Dakota Restaurant Equipment and Supply
517 Airport Road
Bismarck, ND 58504
1-800-279-6151

 

Credit Application

Taylor Dakota Restaurant Equipment
Tom Kambeitz - President
517 Airport Road • Bismarck, ND 58504
Phone: 1-800-279-6151 • Fax: 1-701-223-0028
E-mail: sales@therestaurantoutfitter.com

 

Fill out the following fields or click here to print a form to mail or fax.

 

Lease Information

Total Equipment Costs:

Equipment:

Term of Lease:

Monthly Payment Desired:

 
Buyout Option:

 

Business Information

Business Name:

Contact Name (Required):

Title:

Phone (Required):

FAX:

 

Email:

Address:

City:

State:

ZIP Code:

Type of Business:

Years in Business:

 

Nature of Business:

 

Credit Information

Bank:

Bank:

Account Number:

Account Number:

Contact Name:

Contact Name:

Phone:

Phone:

 

Trade Reference:

Address:

City:

State:

ZIP Code:

Phone:

Trade Reference:

Address:

City:

State:

ZIP Code:

Phone:

Trade Reference:

Address:

City:

State:

ZIP Code:

Phone:

 

Principle's Name:

Social Security Number:

Address:

City:

State:

ZIP Code:

Principle's Name:

Social Security Number:

Address:

City:

State:

ZIP Code:

 

Most Banks and Lenders will not release credit information without customer approval.
 "I hereby authorize the release of credit and financial information."