Full Enrollment Application – OPTIMUS Financing

Step 1 of 4

Name

This field is for validation purposes and should be left unchanged.

Step 1

Personal Information

Person Completing This Application

This field is hidden when viewing the form

Referrer

This field is hidden when viewing the form

Original Email

This field is hidden when viewing the form

Application Type

First Name(Required)

Last Name(Required)

Title(Required)

Email(Required)

Work Phone(Required)

Mobile Phone(Required)

By providing a mobile number, I authorize OPTIMUS to contact me at the phone number I provided via text, an automated telephone dialing system, or artificial or prerecorded voice messages, for any purpose. This is not required to apply. I can opt-out by contacting GreenSky® at 1-866-936-0602 or P.O. Box 24929, Atlanta, GA 30359.

Primary Business Category(Required)

Number of Employees(Required)

Are you an owner?(Required)

Do you have a website?(Required)

Business Legal Name (Merchant)(Required)

Website / Business URL(Required)

This field is hidden when viewing the form

How did you hear about OPTIMUS(Required)

Step 2

Business and Owner Information

Business Information

Business Structure(Required)

Type of Service / Product Business Offers(Required)

Doing Business As(Required)

In Business Since(Required)

Federal Tax ID(Required)

Contractor License #(Required)

Annual Consumer Sales Revenue(Required)

Annual Consumer Finance Volume(Required)

Average Ticket(Required)

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

Country(Required)

Different Mailing Address

Mailing address is different form above

Mailing Street Address(Required)

Mailing City(Required)

Mailing State(Required)

Mailing Zip(Required)

Mailing Country(Required)

Principal, Partner or Owner Information

(Please provide all owners who have at least 10% ownership or greater below.)

First Name(Required)

Last Name(Required)

Email(Required)

Mobile Phone(Required)

Title(Required)

Birthdate(Required)

Owner Since(Required)

Social Security Number(Required)

Social Security Number will be used to verify company ownership

% Ownership(Required)

Please enter a value between 1 and 100

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

Country(Required)

Add Additional Owner

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Title(Required)

Birthdate(Required)

Owner Since(Required)

Social Security Number(Required)

Social Security Number will be used to verify company ownership

% Ownership(Required)

Please enter a value between 1 and 100

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

Country(Required)

Add Additional Owner

Owner 3 First Name(Required)

Owner 3 Last Name(Required)

Owner 3 Email(Required)

Owner 3 Phone(Required)

Title(Required)

Birthdate(Required)

Owner Since(Required)

Social Security Number(Required)

Social Security Number will be used to verify company ownership

% Ownership(Required)

Please enter a value between 1 and 100

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

Country(Required)

Add Additional Owner

Owner 4 First Name(Required)

Owner 4 Last Name(Required)

Owner 4 Email(Required)

Owner 4 Phone(Required)

Title(Required)

Birthdate(Required)

Owner Since(Required)

Social Security Number(Required)

Social Security Number will be used to verify company ownership

% Ownership(Required)

Please enter a value between 1 and 100

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

Country(Required)

Appliances
Basement - Finishing / Remodeling
Basement - Foundation
Basement - Waterproofing
Billiards and Gameroom
Carports/Portable Buildings
Concrete / Masonry
Construction
Construction - Outdoor
Consumer Electronics
Electrical
Fencing - Pet Containment
Fitness / Cycling / Sporting Equipment
Flooring - Coatings
General Contracting
General Merchandise Retailer
Generators
Home Automation
Home Furnishings and Housewares
Home Improvement and Tools
HVAC
Plumbing
Pools
Premium Furniture and Mattresses
Remodeling
Roofing
Siding / Decks
Solar
Spas and Saunas
Walk-In Tub
Water Treatment
Windows and Doors
Other

OPTIMUS Enrollment Application