FIRST INDUSTRIAL FUNDING

CREDIT APPLICATION
 
Full Company Name : ________________________ Corporation _____________________
Address:___________________________________ Proprietorship ___________________

City: ____________ State: ___ Zip Code: ________ Partnership ______________________

Phone Number: _____________ Fax : ___________ Year Started _____________________

 

PRINCIPAL INFORMATION

 

Name Address Social Security #

_________________ ______________________________ _______________

_________________ ______________________________ _______________

 

CREDIT REFERENCES

 

Bank ______________ Contact _______________ Acct# ___________ Phone ___________

Trade ______________ Contact _______________ Acct# ___________ Phone ___________

Trade ______________ Contact _______________ Acct# ___________ Phone ___________

 

SELLER OF PROPOSED EQUIPMENT

 

Company Name ______________________________________ Contact _______________________

Address _______________________________________ Phone ___________ Fax _________

 

EQUIPMENT INFORMATION

 

Make ___________________ Model # ____________________ New ___ Used ___ (year model)

Type of machine (lathe, mill, etc$(B!D(B) ______________________________________________

Approximate Cost ______________________ Delivery status _______________________

 

Financing Information

 

Term: 36 months _____ 48 months _____ 60 months _____ Other _____(please specify)

Buyout: $1.00 ________ 10% __________ FMV__________ Loan ______

LESSEE AUTHORIZATION TO RELEASE INFORMATION The undersigned individual, who is either a principal of the credit applicant or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

 

By: ____________________________________ By: ____________________________________ Date:__________________________

1) Principal release 2) Principal release

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial if such statement is requested in writing within 60 days from the date you are notified of the denial decision. To obtain the statement, please contact 1-877-388-7375. We will send you a written statement of reasons for the denial within 30 days of receiving your request. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant$(B!G(Bs income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is Federal Trade Commission, Equal Credit Opportunity, Washington, D.C.

Please fax the completed application to Steve Miller at (704) 658-1703

If you have any questions please call Steve Miller toll free at (888) 875-6903