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APPLICANT BUSINESS INFORMATION
Company Legal Name:
DBA (If applicable)
Company Address:  
City, State, Zip:  ,
Telephone Number: Fax Number:
EMail Address:
Date of Incorporation: Federal Tax I.D. #:
Business Type: Sole Owner Partnership Corporation Other
Years in Business:
BUSINESS BANK REFERENCES
Business Bank/Branch: Officer/Phone:
Account Number: Type: Checking Savings Money Market
Loans at this bank: Yes No     Date Opened:
Business Bank/Branch: Officer/Phone:
Account Number: Type: Checking Savings Money Market
Loans at this bank: Yes No     Date Opened:
LOAN & TRADE REFERENCES
Firm Name:   City:   State:
Contact:   Phone:
How Long?   High Credit
Firm Name:   City:   State:
Contact:   Phone:
How Long?   High Credit
PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS
Owner 1 Name:
Title:
SSN#:  
Home Telephone:
Home Address:
City, State, Zip: ,
Previous Address:
(If Less than two years)
Owner 2 Name:
Title:
SSN#:  
Home Telephone:
Home Address:
City, State, Zip: ,
Previous Address:
(If Less than two years)

VENDOR & EQUIPMENT INFORMATION

Vendor Name:
Contact:  
Phone:
Fax:
Address:  
City, State, Zip ,  
Equipment Description:  
Is the Equipment
New or Used?
Cost (without Tax):
Monthly Payment:
Terms Requested: 2 Years 3 Years 4 Years 5 Years Special
Location of Equipment:

By submitting this application, I, authorize Eastcoast Leasing Group, it's agents or assigns to investigate my/our credit worthiness, as you deem necessary. I/We hereby authorize my/our references and/or any Credit Bureaus to release my/our information. I/We warrant that the information submitted herein is true and correct.

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