BEACON
FINANCIAL, AC. CREDIT APPLICATION
PLEASE PRINT ALL
INFORMATION
BROKER:
LESSEE COMPANY INFORMATION
Company
Name Federal
Tax I.D. Number
Company Address City County State Zip
Contact Title Telephone
Number
Nature of
Business Type
of Business: Non-Profit
Proprietorship Partnership
Corporation Business
Started
PERSONAL INFORMATION ON
OFFICERS, PARTNERS, OR GUARANTORS
Name Title Social
Security Number
Home Address City State Zip How
Long? Home Phone Number
Previous Address City State Zip Percent
of Business Owned
Name Title Social
Security Number
Home Address City State Zip How
Long? Home Phone Number
Previous Address City State Zip Percent
of Business Owned
EQUIPMENT INFORMATION
Supplier Product
Description (manufacturer, model, serial number); attached separate list if
necessary)
Address
City, State, Zip
Contact/Telephone
Number Total
Cost
COMPANY BANK INFORMATION –
TWO YEAR HISTORY
Name
of Bank/Branch How
Long? Chkg. Acct. # Telephone
No. Contact
Officer
Loan Acct. #
Name
of Bank/Branch How
Long? Chkg. Acct. # Telephone
No. Contact
Officer
Loan Acct. #
Name
of Bank/Branch How
Long? Chkg. Acct. # Telephone
No. Contact
Officer
Loan Acct. #
TRADE REFERENCES – TWO YEAR
HISTORY
Name of Supplier City
/ State Telephone
No. Contact
Person
Name
of Supplier City
/ State Telephone
No. Contact
Person
Name
of Supplier City
/ State Telephone
No. Contact
Person
LEASE REFERENCE
Name
of Lessor City
/ State Telephone
No. Contact
Person
Insurance
Company City
/ State Telephone
No. Contact
Person
Applicant
authorizes the release of any credit information for the company and
individuals listed above including credit reports, loan, lease, checking,
saving, and trade accounts to Beacon Financial Ltd., and/or any of its
assigns. Applicant warrants that the
information stated above is true and correct.
Authorization is granted to use photo or fax copies of my signature to
obtain information.
Signature: X
_______________________________________ Date: ______________________________