Company Name:
DBA:
Company Address:
City, State, ZIP:
Tax I.D.:
Date Business Started:
Contact Person:
Email:
Phone:
Fax:
Type of Business: ---CorporationLLCSole Prop.Partnership
Name:
Title:
SSN:
Ownership %:
Home Address:
Current Business Bank:
Open Date:
Account #:
Bank Phone #:
Bank Contact Person:
Previous Bank (if less than 2 yrs): Open Date:
Bank Contact:
Vendor Company:
Vendor Phone:
Vendor Address:
Vendor Website:
Vendor Email:
Equipment Cost:
Equipment Description:
By electronically signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application.
First Name:
M. Initial:
Last Name:
Date: