United Leasing, Inc. - Commercial Application for Financing

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COMMERCIAL APPLICATION FOR FINANCING

Type of application:

Individual Joint Business
Please make a selection.

CORPORATE INFORMATION
Company Name:	DBA (if applicable):	Owner Name(s)/Percent of Ownership:
Type of Business: Please select an item.	Nature of Business:	Website Address: Must be a complete url.
Company Address:	City:	State:	Zip:	County:
Fed. Tax ID#:	State Organizational #:	Years in Business:	Years Owned by Current Owner:

Business Contact
Contact Name:	Title:	Phone:	Fax:	Cell:	E-mail:

Business Insurance
Agent Name:	Agent Address:	City:	State:	Zip:	Business Phone:
Amount Insured:

PERSONAL INFORMATION ON OFFICERS, OWNERS, OR GUARANTORS (If more than one, please complete seperate application.)
Name:	Title:	Date of Birth: Invalid format	Social Sec #:	U.S. Citizen: Yes No Please make a selection.	Home Phone:
Cell Phone:	E-mail Address: Invalid format	Married: Yes No Please make a selection.

Spouse Information
Name:	Title:	Date of Birth:	Social Sec #:	U.S. Citizen: Yes No Please make a selection.	Phone:
Cell Phone:	E-mail Address:

Residential Information
Residential Status: Please select an item.	Other:	Present Address:	City:	State:	Zip:
County:	How Long Yrs:	How Long Months:	Landlord/Mortgage Holder:	Purchase Price: Numbers only, please.	Rent/Mortgage Pmt: Numbers only, please.
Mortgage Balance: Numbers only, please.

Employer Information
Occupation:	Employer:	Address:	City:	State:	Zip:
How Long Yrs:	How Long Months:

Financial Information
Net Worth: Numbers only, please.	Ever filed Bankruptcy? Yes No Please make a selection.	Date: Invalid format	Monthly Income: Numbers only, please.	Income Amt: Net Gross Please make a selection.	Source:
(Alimony, child support and maintenance income need not be disclosed.)

Nearest Relative (Not Living With You)
Name:	Relationship:	Address:	City:	State:	Zip:
County:	Phone:

COMPANY BANK REFERENCES (Checking, Savings, and/or Installment Information)
Bank Name:	How Long:	Acct #:	Contact:	Phone:	Fax:
Bank Name:	How Long:	Acct #:	Contact:	Phone:	Fax:

COMPANY TRADE REFERENCES (Two Year History)
Supplier Name:	How Long:	City/State:	Contact:	Phone:	Fax:
Supplier Name:	How Long:	City/State:	Contact:	Phone:	Fax:
Supplier Name:	How Long:	City/State:	Contact:	Phone:	Fax:

COMPANY BANK REFERENCES (Checking, Savings, and/or Installment Information)
Vendor Name:	Contact:	Phone:	Fax:
Quantity:	New Used Please make a selection.	Description:	Model:	Cost (W/O Tax): Numbers only, please.
Quantity:	New Used Please make a selection.	Description:	Model:	Cost (W/O Tax): Numbers only, please.

I/we hereby authorize United Leasing, Inc., or their agents, to investigate my/our credit worthiness inluding retrieving consumer credit reports at any time. I/We will provide financial statements, tax returns, etc., as you deem necessary. I/we Warrant And Affirm that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information. Further, I/we understand that United Leasing, Inc. reserves the right to reverse any credit decision if the information contained herein is found to be incorrect. I/we warrant that I/we will indemnify United Leasing, Inc. for any and all costs incurred with this application for credit including any cost incurred in the placement of reservation of the intended leased equipment based on information contained herein.

I have read and understand the terms associated with this application:
Please make a selection.

Applicant:		Date: Invalid format
Co-Applicant:		Date: Invalid format