Financing Application
COMPANY INFORMATION
Legal Company Name: Company Address: City Main Company Phone Corp. LLC State Fax Title Title LP Time In Business Cell Phone: Cell Phone: Yrs. Mos. Fed ID# Zip EMAIL: DBA
Primary Contact: Alternate Contact:
Entity Type (Check ONE) Sole Prop
PERSONAL INFORMATION
Officer Name Own: Rent Home Address: Officer Name Own: Rent Home Address: Title City Title City SS# State: SS# State Ownership % Zip
Ownership % Zip
BANK INFORMATION
Bank Name Account Number Contact Phone
TERM OPTIONS
Term Options: 24 36 48 60 Purchase Option $1 10% Monthly Budget $ Naomi Sales Representative:
By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application. SIGNATURE: Title: Date:
SIGNATURE:
Title:
Date:
4220 South 33rd Street, Suite D Lincoln, NE Ph: 402.937.9646 Fax: 402.939.0282 ATTN: Jesse James