300 LACKAWANNA  AVE,  WEST  PATERSON NJ 07424  PHONE: 973-785-3518 FAX: 973-785-2466 

LEGAL

BUSINESS NAME:

 

VENDOR NAME:

ADDRESS: STREET:
CITY: STATE:               ZIP: CITY: STATE: ZIP
PHONE: FAX: PHONE:
  SALES REP:

YEARS

IN BUSINESS:

TYPE

OF BUSINESS:

CORP: PROP: PTSHP: LLC: LLP:  TAX ID:
EQUIPMENT INFORMATION:

EQUIPMENT

            DESCRIPTION:

EQUIPMENT COST:

TERM: LEASE PAYMENT: LEASE OPTION:

EQUIPMENT LOCATION: (if different from above)

BANK (If current account has been open less than two years, include previous back)

BANK:

BANK:

PHONE:

PHONE:

ACCT#

HOW LONG OPEN:

ACCT#

HOW LONG OPEN:

CONTACT

CONTACT:

TRADE (INCLUDE PREVIOUS BUSINESS LEASE OR LOAN REFERENCES)

NAME:

CONTACT:

ACCT#

PHONE:

NAME:

CONTACT:

ACCT#

PHONE:

NAME:

CONTACT:

ACCT#

PHONE:

PERSONAL INFORMATION: PLEASE INCLUDE HOME PHONE#

NAME:

NAME

ADDRESS:

ADDRESS:

CITY:

STATE:         

ZIP:

CITY:

STATE:              

ZIP:

TITLE:

SS#

TITLE:

SS#:

RELEASE: To Whom this may Concern: This will be your authority and my request to release any information requested on my personal or company credit standing.
  SIGNATURE:__________________________________________________________ TITLE:______________________

 

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