Avanti Vending
   3335 Placer St. Ste 113
Redding, CA  96001

  1-800-822-9686

Vending Machine Credit Application

Name of Business  Type of Business: select Sole Owner Partnership Corp  Business Phone  Fax  Email Address  Address  City  State  Zip  County  Years in Business  Fed ID#  Owner Name  Soc. Security  Current residence select rent home owner  Years at residence  Home Address  Home Phone  Cell  Pager  Nearest Relative  Relative Relation  Relative Phone  Primary Bank  Primary Bank Account #  Contact Name  Phone  Non Credit Card Business Reference  Contact Name  Phone  Employer (If employed outside of vending)  Position  Salary $  Phone  Spouse's Employer  Position  Salary $  Phone  Payment Preference Automatic withdrawal Check/Billing Statement  Authorization Buyer authorizes Seller to obtain such information as required concerning the statements contained in the above application for credit and agrees that the application shall remain the Seller's property, is presented for approval only that final acceptance or rejection rest solely with the Seller and should Seller reject the application, Seller is relieved of any further obligation to Buyer.  Position of Signer  Agreed yes  Date(MM/DD/YY)    MM/DD/YYYY   Please enter the types of machines and quantities you would like to finance: