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ATTENTION: MIKE THOMAS

LEASING COMPANY BUSINESS APPLICATION

Business Name_________________________________________________________________________

Business Address_______________________________________________________________________

City ________________________________ State _________________________ Zip ________________

Business Phone _____________________ Business Fax ____________________ #Years in Business ____

Nature of Business ______________________________ DUNS #_____________ Tax I.D. ____________

Officers, Partners, Principals:

Name ___________________________________ Title _____________________ % Ownership ________

Name ___________________________________ Title _____________________ %Ownership ________

Principal Guaranty Information:

Name _________________________________________________________ S.S. # ______-_____-______ 

Home Address__________________________________________________________________________

Home Phone ________________________ Date of Birth ______/_____/______ # Years at Address _____

Company Bank Information:

Bank Name __________________________________ Phone Number _____________________________

Account # ___________________________________ Officer ___________________________________

Company Insurance:

Insurance Company ___________________________ Agency ___________________________________

Agency Address :_____________________________ Agency Phone Number ______________________

Trade References:

Supplier ____________________________________ City _____________________ State ____________

Contact Person _________________________________________ Phone Number ___________________

Supplier ____________________________________ City _____________________ State ____________

Contact Person _________________________________________ Phone Number ___________________

I, the undersigned, certify that everything I have stated in this application and on any attachments is true and correct. 

By signing below, I authorize FEFCO, LLC OR TWIN STATES, OR ANY OTHER LEASING COMPANY, its assigns

and/or designees to verify the information provided, obtain personal credit reports on all principals, obtain company credit

reports, obtain bank and trade references, and any other credit inquiries necessary in connection with this application. 

I authorize all parties contacted to release credit and financial information requested by FEFCO, LLC OR TWIN STATES,

OR ANY OTHER LEASING COMPANY, its assigns and/or designees.

Authorized Signature ____________________________________________ Title ___________________

Office Use Only:

Equipment Description :______________________________________________

Cost: __________________ Term: __________