FinanciaLogic, Inc
Credit Application
ABOUT SSL CERTIFICATES
1. Customer:
Company (legal name)
DBA:
Physical Address:
County:
City:
State:
Zip:
Central Phone Number:
Fax Number:
Contact Person:
Phone Number:
Title
Email Address:
2. Customer Credit Information
Describe Business:
Date Started:
Incorporation Date:
Incorporation State:
Business Type:
Corporation
Sub-S Crop
Partnership
Proprietorship
Not for Profit
Who Owns What Percentage:
Federal Tax ID:
Parent Corporation:
Webpage:
3. Personal Information on Officers, Partners or Guarantors:
Legal Full Name:
Goes by:
Home Address:
Home Phone:
City:
State:
Zip:
Relationship (Title) to Customer:
SS Number:
Signature:
Date:
Legal Full Name:
Goes by:
Home Address:
Home Phone:
City:
State:
Zip:
Relationship (Title) to Customer:
SS Number:
Signature:
Date:
4. Bank & Trade Sheet - (Please provide or complete Bank & Trade Sheet form)
Equipment Location:
Same as above.
Physical Address:
County:
City:
State:
Zip:
6. Vendor Information:
Vendor:
Salesperson:
System(s) Description:
Amount to Finance:
Lease Term Desired:
Estimated Payments:
Anticipated Acceptance Date of All Items:
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