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New Dealer Alchemist Pre-Qual Credentialing Form

Please fill out the below info.

Required Dealer Business Information

Dealer Business License Name (Legal) *

Additional Business Name (DBAs) *

Dealer Business Address *

Dealer Business City *

Dealer Business State *

Dealer Business Zip *

Dealer Business Number *

Required Dealer Signer Information

Signer Full Name *

Signer Title *

Signer Email *

Signer Phone Number *

Signer DOB *

Required Dealership and Signer Documents - [ Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB. ]

Please upload your Dealership's business license (not driver's license) *

Company Principal Information

Principal information will be used to ensure the Company meets Equifax’s credentialing requirements.
A principal is the company owner, founder, CEO, or a Senior Representative (CFO, General Manager, Director) at the company.

Principal’s First and Last Name *

Principal’s Email Address *

Principal’s Title *

Principal DOB – Not required upfront but may be requested in the future.

Dealership Website *

Website Provider for Installation *

DealerAlchemist Account Manager Name

DealerAlchemist Account Manager Email

CRM Provider

OEM Dealer Code

Pre Approval Options

Pre Approval Credit Threshold Preferred CTA Verbiage

Assigned Lenders - (Read Only)

Additional Lenders - (Optional)

Additional Dealer Access Information - (Not Required to Order)

CRM Email Address(es) for Sales Lead Routing *

Usernames & Website Access

Users who need to attend training and setup for backend access to Dealer Alchemist Soft Credit Pull. Please be sure to include anyone who will require backend access on launch day.

First Name & Last Name

Email Address

Cell Phone Number

First Name & Last Name

Email Address

Cell Phone Number

First Name & Last Name

Email Address

Cell Phone Number

First Name & Last Name

Email Address

Cell Phone Number

First Name & Last Name

Email Address

Cell Phone Number