COMPANY INFORMATION (Please
list Legal Name. If there is a d/b/a please indicate)
Legal Name of Company :
Business Address :
City/State/Zip :
Billing Address
(if different from above)
Address :
City/State/Zip :
Phone:
Fax :
Cell:
Contact :
Website:
E-Mail Address :
Time in Business :
Yrs Fed Tax ID #:
# of Employees:
Nature of the Business :
Type of Business :
OWNER DATA (Please indicate
all owners with greater than 25% ownership) Attach list
if needed
Principal #1
Address :
City/State :
Social Security # :
Principal #2
Address :
City/State :
Social Security # :
REFERENCES (If you have
a Company Reference List, skip this section and attach)
Business Bank :
Account #
Bank Contact :
Phone:
Fax:
1. Trade Reference :
Phone :
2. Trade Reference :
Phone :
VENDOR'(S) and EQUIPMENT (If
more than one Vendor, attach List of Vendor's & Proposals)
Vendor Name :
Phone:
Address :
Equipment :
Equipment Cost:
NOTE: Please Enclose a Vendor
Proposal, Invoice or Purchase Order with full
description
LEASE STRUCTURE (Please
enter the lease structure you are requesting)
Lease term in Months:
End of Lease Option: $1.00
,10%
, fmv
, Other
Applicant certifies that all credit and financial information
submitted is true and correct. Applicant hereby authorizes
US Business Financial, Inc., its Underwriters and Assigns
to investigate Lessee's credit worthiness, and disclose
their findings to each other. The Undersigned authorizes
all parties contacted to release credit and financial information
as part of said investigation. All duplicates of this document
are to be viewed as an original.
