BUSINESS INFORMATION
Business Name
Fed ID #
Business Type Sole Proprietorship   Partnership   LLC   Corporation  
Date Incorporated
 
Yrs in Business
Yrs Experience
  
Mailing Address
Phone Number

Physical Address

Describe Business:
PERSONAL INFORMATION OF OWNER, OFFICERS, PARTNERS OR GUARANTORS
Principal/Owners Name
Home Address
Home Phone
SSN
Home
  
Rent   Own  
   
   
Bank References - 2 Year History Minimum Required
Name of Bank or Branch
Account or Loan Number
Contact
Phone Number
Date Opened
 
 
 
 
Trade and Finance References
Name of Reference
Account or Reference Number
Yrs of Credit
Phone Number
 
 
 
 
Vendor Information
Vendor's Name Contact Person  
Vendor's Address Phone Number  
Equipment to be Leased or Financed
Leasing Requested    Financing Requested     Undecided
Euipment type  
Lease Term Total Equipment Cost
Amount of Down Payment
 

This application is given for the purpose of obtaining credit. I hereby certify under penalty of law that the above information is a true and complete
statement of my/our financial condition. I/We understand that individual credit histories may be a determining factor in the evaluation of this application. I/We grant permission to DEFTCO.CORP to obtain a personal credit report on all the individuals listed above.

Date Print Name

 

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