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 COMPANY INFORMATION

  Company Name(EXACT LEGAL NAME)
 
  
Telephone Number
Email Address
  Address
  		      City                   Country               State                Zip
  
  Years in Business
 
Sole Prop./Partnership/corporation
  Nature of Business
   
  Company Bank Name
  		Tel. Number/Contact
Account Number
  Company Bank Name(ADD. IF AVAILABLE)
  		Tel. Number/Contact
 Account Number
  Trade References(SUPPLIERS)
  		Tel. Number 
 Contact Person
  Trade References(SUPPLIERS)
 

Tel. Number 

 Contact Person
 PRINCIPAL INFORMATION (ON OFFICERS, PARTNERS OR GUARANTORS)
 
  Name
 
Title
Social Security Number
  Home Address
  		   City       State        Zip
 Home Phone Number
  Name
  		Title:
 Social Security Number
  Home Address
  		   City       State        Zip
 Home Phone Number
 VENDOR INFORMATION (EQUIPMENT SELLER)

  Name
  		Address
    City           State        Zip
  Tel. Name
  		Fax Number
 Sales Contact
  Equipment Type (REQUIRED)
  		Amount (REQUIRED)
Budgeted Monthly Payments
 
Applicant warrants that all the information provided to the Lessor is true and correct, and authorizes Alliance Funding Group, Inc. and/or its affiliates to investigate applicants credit worthiness as may be needed. The undersigned authorizes all banking institutions, credit reporting agencies, trade references and its agents to release all necessary information via telephone, mail or facsimile as requested, for the purpose of securing a lease.


  Customer Name:       

                   Title:       

  Customer Signature:       
            (REQUIRED)
                         Title:       

Copyright © 1999, Alliance Funding Group, Inc.
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