|
City:
|
|
County:
|
|
|
State:
|
|
Zip: |
|
|
Phone:
|
-
- |
Fax:
|
-
- |
| Contact E-Mail Address: |
|
|
Federal Tax ID#:
|
|
Years in Business:
|
|
|
Nature of Business:
|
|
| Business Type: |
| BANK
INFORMATION |
|
Name of Bank:
|
|
Bank Officer:
|
|
|
Phone #:
|
-
- |
Deposit/Check Acct.#:
|
|
|
Loan Acct.#:
|
|
|
Name of Bank:
|
|
Bank Officer:
|
|
|
Phone #:
|
-
- |
Deposit/Check Acct.#:
|
|
|
Loan Acct.#:
|
|
| TRADE
REFERENCES |
|
1) Name of Supplier:
|
|
Contact:
|
|
|
Street Address:
|
|
| City: |
|
| State: |
|
Zip: |
|
|
Phone:
|
-
- |
|
2) Name of Supplier:
|
|
Contact:
|
|
|
Street Address:
|
|
| City: |
|
| State: |
|
Zip: |
|
|
Phone:
|
- - |
| OWNERS,
PARTNERS, OR GUARANTORS |
|
1) Name:
|
|
Title:
|
|
|
Home Address:
|
|
| City: |
|
| State: |
|
Zip: |
|
|
Home Phone:
|
-
- |
SS#:
|
-
- |
|
2) Name:
|
|
Title:
|
|
|
Home Address:
|
|
| City: |
|
| State: |
|
Zip: |
|
|
Home Phone:
|
-
- |
SS#:
|
-
- |
| Equipment Information
(including quantity, make and model): |
|
| VENDOR
INFORMATION |
|
Name:
|
|
|
Contact:
|
|
|
Address:
|
|
| City: |
|
| State: |
|
Zip: |
|
|
Phone:
|
-
- |
Fax:
|
-
- |
| The persons(s) supplying the above
information certifies to Marlin leasing Corp. that it is true and
correct. The Owners/Partners/Guarantors authorize Marlin Leasing
Corp. to investigate his/her personal credit status, including
consumer credit reports. |