BUSINESS LEGAL NAME (include DBA) FEDERAL ID#
Check One :
 Proprietorship Corporation  Specify other
LLC Partnership
       
Street Address Telephone
City Fax#
State E-Mail
Zip Code Contact
Type of Business Year Started

Tax Exempt No. (if applicable)

 

 

Owner/ Guarantor 1.

 
 Name
Social Security No.

Percent owned
Home Address

City
State

Zip Code
  

Owner / Guarantor  2.

Name
Social Security No.

Percent owned
Home Address

City
State
Zip Code
 
Primary Bank

Lease/Loan Source

City City 
State State
Contact Contact
Telephone Telephone
Account # Account #
     
Trade    
City    
State    
Contact Name    
Telephone    
Account No.    
     

Vendor 1

Vendor 2

City City
State State
Contact Contact
Telephone Telephone
     
Equipment Being Purchased    

Piece 1

  

Piece 2

  
Year Year
Make  Make
Model Model
Serial No. Serial No.
Price (US) Price (US)
    

Piece 3

  

Piece 4

  
Year Year
Make  Make
Model Model
Serial No. Serial No.
Price (US) Price (US)
       
Finance Information (US Dollars)  

Total Cost of Equipment

 

Trade Allowance (if applicable)

 

Down Payment

 

Sales Tax

 

Other Charges

 

TOTAL AMOUNT TO FINANCE

 
       
Program Requested :    
Loan

Requested Term:

Other
Lease

Requested Term:

Other

Request Purchase Option:

Other
 
Additional Comments or Questions

CREDIT REVIEW AUTHORIZATION

In order to process this application for financing I authorize Harry Fry & Associates and it's agents to obtain all credit information from any bank, creditor, trade account or credit reporting agency for the purpose of credit review. I warrant that the information submitted herein is true and correct and understand that any credit decision can be reversed if the said information is found to be incorrect or not true.

Name

Title

Today's Date

   


 

 
 


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