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Applications
Partnering with bsbFUNDING.
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Important to set out the full legal name of Lessee
Fed. Tax I.D. #
CO State I.D.#
Company Name & w/dba
Billing Address
City
County
State
Zip
Telephone No.
Fax No.
Contact Person
Title
No. of Years in Business
Nature of Business
Type of Business
Proprietorship
Partnership
Corporation
LLC
EQUIPMENT LOCATION
EQUIPMENT LOCATION Complete only if equipment will not be located at Lesseeās billing address
Address
City
County
State
Zip
PERSONAL INFORMATION ON MAJORITY STOCKHOLDERS/OWNERS
Name
Title
% of Ownership
Social Security No.
Home Address
City
State
Zip
Home Phone No.
Name
Title
% of Ownership
Social Security No.
Home Address
City
State
Zip
Home Phone No.
COMPANY BANK REFERENCES
MUST HAVE TWO YEAR HISTORY (Important to establish any loan history)
Name of Bank/Branch
How Long?
Chkg. Acct. #
Loan. Acct. #
Telephone No.
Contact Officer
Previous Bank (If account is less than 2 yrs. old)
How Long?
Chkg. Acct. #
Loan. Acct. #
Telephone No.
Contact Officer
TRADE REFERENCES AND OTHER LEASES
TWO YEAR HISTORY (Important to establish high credit and payment history)
Name of Supplier
City/State/Zip
First
Middle
Last
Telephone No
Contact Person
Name of Supplier
City/State/Zip
First
Middle
Last
Telephone No
Contact Person
Name of Supplier
City/State/Zip
First
Middle
Last
Telephone No
Contact Person
EQUIPMENT TO BE FINANCED
Attach separate list if necessary
Quantity:
Description:
Checkboxes
New
Used
VENDOR INFORMATION
Vendor Name
Equipment Cost$
Vendor Address
Telephone No
Fax No.
LOAN TERM
Checkboxes
12 Months
24 Months
36 Months
48 Months
60 Months
AUTHORIZATION FORM:
By signing below, each undersigned individual (s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Procure Financial Services dba bsbFUNDING. or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purposes of update, renewal or extension of such credit and for reviewing or collecting the resulting account. I authorize all deposit, borrowing, and trade information to be released to the Lessor. I represent all information is true, correct and complete. A photo static or facsimile copy of this authorization shall be as valid as the original.
a. Name (Please Print) -
Single Line Text
Single Line Text (copy)
b. Title -
Single Line Text (copy)
Single Line Text (copy) (copy)
c. Date -
Date / Time
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