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Please describe what your financial needs are:
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| Please be specific (e.g., if applying for equipment financing, include the year, make, model, miles, hours, etc. For Dump Trucks and Specialty Trucks we also need the year, make, and model of the dump body or other equipment.)
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BUSINESS INFORMATION
* Required fields.
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| * Company Name: |
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* Business Phone: |
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* Business Fax: |
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| * Business Address: |
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* City: |
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* State: |
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* Zip Code: |
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Federal I.D. No: |
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* Date Started: |
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* Type of Incorporation/ Ownership:
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* Type of Business: |
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# of Employees: |
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Alternate Phone Number: |
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OWNER 1
* Required
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| * Full Legal Name: |
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* Title: |
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* Ownership %: |
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* SSN Number: |
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Home Phone: |
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Cell Phone Number: |
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Alternate Phone Number: |
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* Email Address: |
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* Home Address: |
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* City: |
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* State: |
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* Zip Code: |
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| OWNER 2
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Full Legal Name: |
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Title: |
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Ownership %: |
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SSN Number: |
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Home Phone: |
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Cell Phone: |
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Alternate Phone Number: |
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Email Address: |
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Home Address: |
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City: |
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State: |
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Zip Code: |
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* Terms of Financing: |
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* Purchase Price: |
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| Down Payment Amount? |
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Vendor(s) Name(s): |
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Phone: |
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Contact: |
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* Has Any Owner/Officer filed Bankruptcy in the last 5 Years?
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Yes
No
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BANKING INFORMATION
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Name of Bank: |
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Contact: |
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Bank Phone Number: |
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Address: |
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City: |
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State: |
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ZIP Code: |
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First Account Number
(savings, checking, other): |
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Second Account Number
(savings, checking, other): |
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SIGNATURE
By checking this box, the Applicant(s) represent and warrant that all credit and financial information submitted is true and correct and that Approved Finance Group and its assigned, may obtain any credit information necessary pertaining to this application.
Submitting this application is equivalent to a signature. |
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