Financing Application Complete your application online below or download our offline application. 1 Business Information 2 Ownership Information 3 Bank/Insurance References 4 Equipment Information 5 Additional Attachments 6 Signatures Page 1 of 6 Business Information Please correct the following errors and try again: Business Name (Legal) Trade Name (DBA) Type of Business Physical Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Contact Name Email Address Telephone Fax Equipment Location Include if different from above. Ownership Proprietorship Partnership Corporation Tax ID Number of Employees Business Start Date Website Principal #1 Principal Name Title Percent Ownership Home Phone Social Security # Date of Birth Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Principal #2 Principal Name Title Percent Ownership Home Phone Social Security # Date of Birth Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Banking Reference Bank Name If less than two years, attach previous bank information as well. Checking Account # Savings Account # Loan Account # Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Contact Officer Phone Insurance Reference Insurance Agent Phone Agent's Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Sales Quote If you have a sales quote from your vendor, you may attach it here. Equipment Cost Exclusive of Sales Tax New or Used? New Used Lease Term Monthly Payment Lease Plan FMV $1 10% Other Equipment Description Manufacturer, Model #, Serial #, Year Supplier Contact Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip As needed, attach a copy of your driver's license, bank statements, tax returns or other relevant documentation. Attachment #1 Attachment #2 Attachment #3 Attachment #4 Attachment #5 I/We hereby authorize the release of any and all credit information to Westtown Leasing Corporation and its assigns or agents from the above listed references, and certify that all is true and correct to the best of my knowledge. The undersigned individual(s), recognizing that his/her/their individual credit histories may be a factor in the evaluation of the credit application, hereby consents to and authorizes the above named business credit provider to verify all information provided, and to obtain and use a credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process. Principal #1 Please sign above using your finger or mouse. Clear Signature Principal #2 Please sign above using your finger or mouse. Clear Signature You must enable JavaScript to submit this form Next « Back