INFORMATION SHEET
Phone: 678-367-0459 ext 6954 Fax: 678-804-1811
APPLICANT INFORMATION
C ompany Name
S treet Address
C ity, State, Zip
T elephone
Fax
C ontact/Title
F ederal Tax ID #
Time in Business
TYPE OF ENTITY Corp. (Public/ Private) S-Corp. Limited Liability Corp. Proprietor Partnership
CORPORATE GUARANTOR Not Applicable
C ity, ST, Zip
TEL #
PERSONAL GUARANTOR(s)
N ame
Name
H ome Address
Home Address
City, ST, Zip
SS # / % Owned
SS # / % owned
Signature
EQUIPMENT INFORMATION (Attach additional sheets if necessary and any specifics available)
NEED FOR EQUIPMENT: New Used Replacement/Refinance Expansion Other
Quantity
Year
Make/Model
Equipment Description
Equipment Location
Cost (Per Item)
VENDOR INFORMATION
BONDING COMPANY ( NOT insurance agency)
V endor Name
Company Name
Street Address
P hone/Contact
Phone/Contact
INSURANCE INFORMATION
Contact
Telephone
Commercial Asset Funding Page 2
REFERENCES (List your company's bank and 3 largest secured creditors)
B ank
Acct #
S ecured Creditor
COMPANY HISTORY
PLEASE PROVIDE A BRIEF OVERVIEW OF THE COMPANY, PAST AND PRESENT INCLUDING OWNERSHIP & MANAGEMENT. ALSO INCLUDE
ANY INFORMATION YOU FEEL IS PERTINENT TO OUR CREDIT INVESTIGATION
INFORMATION DISCLOSURE AUTHORIZATION (PLEASE HAVE AUTHORIZED SIGNER COMPLETE)
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 Lender or 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 accounts. 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. The Undersigned hereby authorizes past and present depositing institutions, creditors, vendors and suppliers of the Undersigned to provide such information pertaining to any loans, leases, lines of credit, account balances, and payment histories of the Undersigned to Rigby Brothers Inc and/or its designees or assigns as it may request.
By (Signature)
P rint Name
T itle