Pay Here Marketing Pre-Qual Credentialing Form
Please fill out the info below.
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.
Company Website
*
PayHereMarketing Account Manager Name
PayHereMarketing Account Manager Email
CRM Provider
None
AutoAlert CXM
CDK eLead1One
DealerSocket
DriveCentric
Lightspeed
Others
ProMax
Tekion
VinSolutions
Additional Dealer Access Information -
(Not Required to Order)
ADF Email Addresses
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
Submit
Reset
