Commercial Credit Application

    COMPANY INFORMATION
    Business Legal Name:
    DBA (If applicable):
    Street Address:
    City:
    State:
    ZIP:
    Phone:
    Business Description:
    Annual Revenue (gross):
    Industry Type:
    Years in business under current ownership:
    Contact Name:
    Title:
    Cell:
    Email:
    FEIN / Tax ID:
    # of Employees:
    Website:

    Legal Structure:

    Equipment Address (If different from company address):
    Amount:
    Contract Length (In months):

    PRIMARY BANK REFERENCE
    Bank Name:
    Account #:
    Contact:
    Phone:

    LEGAL NAME OF OWNERS, OFFICERS OR GUARANTORS
    (1) Owner/Officer/Guarantor
    Name:
    Title:
    Email:
    Social Security #:
    % Ownership:
    Cell:
    Home Phone:
    Home Address:
    Signature:


    I Agree to the CERTIFICATION AND AUTHORIZATION:
    Date:

    (2) Owner/Officer/Guarantor
    Name:
    Title:
    Email:
    Social Security #:
    % Ownership:
    Cell:
    Home Phone:
    Home Address:
    I Agree to the CERTIFICATION AND AUTHORIZATION:
    Date:

    (3) Owner/Officer/Guarantor
    Name:
    Title:
    Email:
    Social Security #:
    % Ownership:
    Cell:
    Home Phone:
    Home Address:
    I Agree to the CERTIFICATION AND AUTHORIZATION:
    Date:

    CERTIFICATION AND AUTHORIZATION
    By signing above, the applicant and the Owners/Partners/Members/Guarantors agree as follows: They certify that all information provided is true, correct, and complete, and that the property leased or acquired with any credit provided will be used solely for business and commercial purposes. The applicant and the Owners/Partners/Members/Guarantors of the applicant listed above recognize that their individual credit histories may be a factor in the evaluation of the applicant for the credit being applied for and, thus, authorize The Lender or its designee to investigate their organizational and personal credit histories. This includes obtaining information from all sources, including using their consumer credit reports in the credit evaluation and collection processes, and periodically updating any such information.