To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. When you open an account, we will ask your name, address, date of birth and other information that allows us to identify you. We may ask to see your driver’s license or other identifying documents.
 
 Lessee/Business Information

Lessee Full Company Name

D.B.A.

Lessee Full Co. Street Address:

City:

State:

Zip:

Phone:

--

Fax:

 --

Contact E-Mail Address:

Federal Tax ID#:

Date Established:

Nature of Business:

Business Type:

 
 Guarantor 1

Name

Street Address:

City:

State:

Zip:

Phone:

--

Social Security #

--

% Ownership:
 Guarantor 2

Name

Street Address:

City:

State:

Zip:

Phone:

--

Social Security #

--

% Ownership:
 Bank Reference

Name of Bank:

Bank City:

Bank State:

Bank Phone #:

--

Bank Fax #:

--

Account Type:

Account Number:

 
 Vendor Information

Vendor Name:

Contact:

Address:

City:

State:

Zip:

Phone:

--

Fax:

--

E-mail:

Equipment Location:

Equipment Description:

Is Equipment New or Used?

Term:

Purchase Option:

Does Vendor Require Deposit?

Total Invoice W/O Tax: $


The undersigned individual who is either a principal, a personal guarantor or a sole proprietorship of the credit applicant, recognizing that his or her Individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes the above named business credit provider and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, 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 Fair Credit Reporting Act in the absence of this continuing consent.

 I agree.