Dcf

BUSINESS INFORMATION
Business Name:		Time in Businss:		Federal ID:
Contact Name:		Nature of Business:		D&B:
Busines Address:		City:		State:
Business Phone:		Cell Phone:		Zip:
Email Address:		Fax:
Equipment Location: (if different from above)
OWNERS-OFFICERS-GUARANTORS
Owner 1 Name:		Home Address:		Social Security:
		Title:		Ownership %:
Owner 2 Name:		Home Address:		Social Security:
		Title:		Ownership %:
BANK-FINANCE-LEASING REFERENCES
Name:		Contact:		Phone:
EQUIPMENT AND VENDOR INFO
Vendor Name:		Equipment:
Address:		New or Used?	..... New Used
Phone:		Cost:
Contact:
PLEASE READ BEFORE SUBMITTING
Lessee represents and warrants that all credit and financial information submitted to lessor is true and correct and lessor may use any information necessary pertaining to this application including, but not limited to, owners, officers or guarantors.  By submitting this form, the applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit of the applicant, hereby concents to and authorizes the leasing company and any assignee, lendor or funding service that may be utilized, to obtain and use a consumer credit report on the applicant, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under the fair credit reporting act in the absence of this continuing concent.