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Credit Application

Company Information
 
Legal Business Name
Fed. Tax ID #
DBA Name
Physical Address
Street
City
State
Zip
Phone #
Fax #
Email
 
Type of Business
Years in Business
# of Employees
Business Structure
C-Corp
S-Corp
LLC
Partnership
Sole
Other
   

Ownership Information
 
Name 1
Phone #
Home Address
Street
City
State
Zip
Ownership %
 
SS#
Title
 
Name 2
Phone #
Home Address
Street
City
State
Zip
Ownership%
 
SS#
Title:

Banking Information
 
Bank Name
City/State Located
Bank Phone #
Fax #
Contact Person
Acct#
Account Type

Other Loans/Leases
 
Bank Name
Acct#
Phone#
Contact
Lessor
Acct#
Phone#
Contact

Trade References
 
Reference #1
Phone #
Contact(s)
City/State Located
 
Reference #2
Phone #
Contact(s)
City/State Located
 
Reference #3
Phone #
Contact(s)
City/State Located
   
Equipment Information
 
Vendor Name
Contact Name
Phone #
Cost (before Taxes)
New
Used
Equipment Description/Model #
Lease Term
24 Mo
36 Mo
48 Mo
60 Mo
72 Mo

 


I hereby authorize our Bank(s), Trade References, and Financial Institutions the right to release credit information to First Alliance Capital, LLC and/or its assigns. Furthermore, each undersigned individual(s), who is either a corporate officer or principal of the credit applicant provides written instruction to Lessor and/or any assignee authorizing review of his/her personal credit profile from a national credit bureau. A photocopy or facsimile of this authorization shall be as valid as the original. All accompanying Financial Statements and other such required materials needed for this transaction to be funded are warranted to be true, correct, and complete.



 
Title
Date
Title
Date
First Alliance Capital, LLC. 9891 Irvine Center Dr, Suite 200 Irvine CA 92618
Phone: 714-791-3505 Email: info@firstallianceonline.com
2004 First Alliance Capital, LLC. All rights reserved