|
PRINT THIS PAGE, FILL IT OUT, AND FAX IT TO: (704) 272-0175
You may need to print in landscape mode in lieu of portrait mode.
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: __________
|
