Peoples Business Finance

Online Credit Application

Fields marked with a * are required fields. Also, please enter at least one form of contact (phone number, E-mail address, fax number, or U.S. Postal address).

LESSEE

*Legal Business Name:	*Contact:	Phone:
Trade Name(if applicable):	Email:	Fax:
Business Street:	City:	State:
Zip:	Years in Business:	Tax ID No:
Type of Business:	Type of Business:	State Incorporated(if applicable):

PRINCIPALS(Owners, partners and principal officers)

Name:	Title:	Home Phone:
Home Address(street):	City:	State:
Zip Code:	Social Security No:	US Citizen?:	Yes No
Email:

Name:	Title:	Home Phone:
Home Address(street):	City:	State:
Zip Code:	Social Security No:	US Citizen?:	Yes No
Email:

VENDOR

Business Name:	Contact:	Phone:
Home Address(street):	City:	State:
Zip Code:	Email:	Fax:

EQUIPMENT

Equipment Location:		Credit Requested: $
Quantity:	Check if equipment is used
Make & Model:	General Description:

Quantity:	Check if equipment is used
Make & Model:	General Description:

Quantity:	Check if equipment is used
Make & Model:	General Description:

KEY TERMS

Lease Term(months):
Purchase Option:
Fair Market Value	Estimated Fair Market Value of % of the total equipment cost
Nominal Price of $	Nominal Price of % of the total equipment cost

REFERENCES

Bank:	Account Number:	Contact:	Phone:
Trade Creditor:	Account Number:	Contact:	Phone:
Secured Debt or Lease Creditor:	Account Number:	Contact:	Phone:

Customer Comments:
*Disclaimer:	I have read and understood the Disclamer of Peoples Business Finance.com

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