WashMart Finance Form

Social Security Number of Owner *
Estimated Personal Credit Range
Date of Birth of Owner *

Month Day Year
Applying as *

Sole Proprietor Partnership Corporation LLC Start-up
Business Legal Name *
Please enter the name exactly as it appears on your proof of business document
Federal Tax ID (EIN) *
If no EIN, use SSN for business owner
Business Address - If Home Based, leave this blank

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Years in Business
Enter the total years you have been legally operating that can be documented
Photo Identification of Owner - Front

Upload a File
Unexpired, government issued photo ID Cancel of
Photo Identification of Owner - Back

Browse Files
Unexpired, government issued photo ID Cancel of
Proof of Business and Ownership

Upload a File
Official Document listing the business name and owner(s) name Cancel of