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Vending Machine Financing Application

Please download the PDF Application or contact us to thave this form faxed to you.

Financial Application

Please read before submitting your application online

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

Name of Business*:

Type (check one):

Sole P Partnership Corp







Zip Code:


Years in Business

Federal ID #:

Dun&Brad #:

Owner Name /
Authorized Signer:

Social Security:



Number of Years at Current Address:


Home Owner or Renter:

Home Owner: or  Renter:

Home Address:

Home Phone:


Nearest Relative:

Relation to Relative:

Relative's Phone:





Primary Bank Name:

Primary Bank Account#:

Contact Name:

Contact Phone:



Non-Credit Card Business Reference:

Non-Credit Card Account#:

Contact Name:

Contact Phone:



Employer (If Employed Outside of Vending):


Employer Phone:


Spouse's Employer:

Spouse's Position:

Spouse's Salary

Spouse's Phone:



Payment Preference (check one):

Automatic Withdrawal:     Pay By Check/Billing Statement:

Print/Sign Name*:



For immediate information, please contact Peter LeVine or any one of his talented colleagues at (800) 223-4101, (650) 493-2258, or contact us through our

All vending machines are priced lower than the identical machines from Selectivend, USI, Fawn, or Federal.

Plus we offer:

  • Zero Down Financing
  • Lower Interest Rates

Questions? (800) 223-4101 or email us


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Stanford Financial Square      2600 El Camino Real      Palo Alto, CA      94306     (800) 223-4101     (650) 493-2258