Become a Sunshine State Credit Provider

Simply fill out the form below to apply.

Information Regarding Your Business

 
    MC/VISA     CARE CREDIT     DISCOVER     AMEX     OTHER

YES     NO
If you do not have a Florida Documentary Stamp Tax ID # please go to this website and get one as soon as possible. You will have to provide us with this Id number before we can start doing business. However it is not required to complete the Sunshine State Credit Provider Application. For information about Florida Documentary Stamp Tax please click here.

Main Office Address

 

Who at your company is the decision maker for business related activities?

 

Who will be Sunshine's main contact at your business for day to day operations?

 

List all Officers/ Shareholders for the corporate name listed on this application.

 

Additional Comments

 

Sunshine State Credit (Sunshine) Provider Application. This Provider Application (“Application/Applicant”) is submitted to Sunshine to determine if the Applicant(s) are eligible to join the Sunshine State Credit programs.

By signing below, Applicant(s) hereby represents, acknowledges, agrees, authorizes and confirms the following:

  1. The undersigned(s) has the legal capacity to execute this Application and is executing this Application as an Officer and or Owner of Applicant.
  2. If Applicant is not a separate legal entity, then each of the undersigned is executing this Application in his or her individual capacity as the business owner.
  3. Applicant has reviewed this application and all information provided herein is true and complete.
  4. This Application is subject to approval by Sunshine.
  5. Sunshine or its agents, may retain possession of this Application, rely on the information and statements herein, check and verify Applicant's credit and background history and employment history, secure follow up credit reports, and exchange information about Applicant and this account with creditors, credit bureaus, and other proper persons.
  6. The terms and conditions of the Sunshine State Credit Master Agreement (the “Agreement”) will be delivered to Applicant subject to the Applicant being approved by Sunshine.

Provider Application Authorization
Each person executing this Application, on behalf of such person and the Applicant, hereby certifies that questions on this Application have been answered fully and truthfully, and herby authorizes you, your representatives and agents: (i) to verify any information provided on this Application including but not limited to obtaining credit reports, background reports and contacting references, employers, landlords, and creditors; (ii) to obtain credit reports and background reports for purposes of reviewing or taking collection action on this Application, or for other legitimate purposes associated with establishing an account with you, as permitted by law; and (iii) to exchange information about the undersigned and this Application with my creditors, credit bureaus, and other entities or persons. Once this Application is submitted to you, you may retain it whether or not this Application is approved. The undersigned(s) authorize(s) you to communicate with the undersigned about this Provider Application via mail, messenger service, e-mail, text messaging, cell phone, and landline phone using the contact information provided in this Provider Application. Each of the undersigned has read, understand and agree with the terms and conditions of the Provider Application Authorization.

I \ we have read, understand and agree with the terms and conditions of the Provider Application Authorization. Please select “I Agree"