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Vendor Credit Application

Company Information
 
Legal Business Name
Fed. Tax ID #
DBA Name
State of Incorporation
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
   

Owners, Officers, or Guarantors Information
 
Name 1
SS #
Home Phone #
Home Address
Street
City
State
Zip
Years at Present address
Ownership %
 
Title
Drivers License #
State
 
Name 2
SS #
Home Phone #
Home Address
Street
City
State
Zip
Years at Present address
Ownership %
 
Title
Drivers License #
State
   
   

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

Trade References
 
Reference #1
Phone #
Contact(s)
Account#
 
Reference #2
Phone #
Contact(s)
Account#
 
Reference #3
Phone #
Contact(s)
Account#
   

Equipment Sold Information
 
Type(s) of Equipment Sold
Average Cost
Avg. # of Deals per Month
Target Market
New
Used


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 information and other such required materials needed  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