CREDIT APPLICATION 
Send to: 
Covington Vending
1682 Wallenberg Blvd. 
Charleston, SC 29407 
Fax to 843-769-0292 


Sales Information 

Name of your Salesperson: (If you do not have a salesperson enter “None”) 
Amount of Credit Requested (check one): ___$0 - $5000 ___$5,000 - $25,000 ___$25,000+ 

Customer Information 

Current Finance Customer? ___Current Customer ___ Past Customer ___ New Customer Finance Customer #: _______________ 
Legal Business or Customer Name: ________________________________________________ D/B/A Name (if any) ______________________________________ 
Type of Business (Check One): ____Sole P ____ Partnership ____ Corp 
Years in Business: ______ yrs. 
Number of Routes: _________ Number of Locations: _________ Number of Machines: _________ Annual Sales: _______________ 
Business/Customer Address: __________________________________ City: _______________________________ State: __________ Zip code: _____________ 
Business/Customer Phone: _______________________________ Cell/Alternate Phone: _______________________ Fax # : _______________________________ 
E-mail Address: _______________________________ 
Owner/Authorized Signer 1 Name (Print): ______________________________________________ Social Security No: ____________________________________ 
Owner/Authorized Signer 2 Name (Print): _______________________________________________ Social Security No: ____________________________________ 


Credit Information 

Check One: _____ Home Owner _______ Renter Number or Years at address: ________________ 
Home Address: _____________________________________ City: __________________________ State: _____________________ Zip code: ________________ 
Home Phone: ________________________ Cell Phone: _______________________________ Pager # ________________________________ 
Nearest Relative not Living with Customer: ________________________________________ Relationship: ______________________ Phone # _______________ 


Employed Outside Vending Business: ____ Yes _____ No 
Employment Information (If employed outside business or in business less than one year) 

Name of Employer of Signer 1: _________________________ Salary ____________ Position ____________ Phone # ________________ Yrs Employed ____ 
Name of Employer of Signer 2: _________________________ Salary ____________ Position ____________ Phone # ________________ Yrs Employed ____ 

Trade References 
Name: __________________________________ Phone #: __________________________ Account # ______________________________________________ 
Name: __________________________________ Phone #: __________________________ Account # ______________________________________________ 
Name: __________________________________ Phone #: __________________________ Account # ______________________________________________ 

For purchases over $25,000 we will require the submittal of, 1) last years tax returns and/or 2) current year to date Profit & Loss statement. Please feel free to fax this 
information to our secure fax line 843-769-0292. 

I understand that Wittern Financial Services is relying on this information in extending credit and I warrant it to be true. I hereby authorize WFS or any bank/and or 
trade bureau or other investigative agencies employed by WFS to investigate the references herein listed or other data obtained from me or any other person pertaining 
to my credit and financial responsibility. The undersigned authorizes all parties contacted to release credt information requested or its successors or assigns. 

Signature (position of signer) Signature (position of signer) Date