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YANDELL & COMPANY
APPLICATION
685 West End Avenue Suite 15A New York, NY 10025 617-735-9188/
617-812-8448 fax |
LESSEE /
BORROWER
VENDOR
Company Name: ___________________________ Company
Name: _______________________
D/B/A Name: ______________________________ Address:
_____________________________
Address: __________________________________
City:_____________ State:___ Zip: _______
City: _____________________________________ Phone #:
____________ Contact: _________
State: ____ Zip: ________ County: ____________
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BANK REFERENCE
Phone #: _____________ Fax #: ______________ Principal Bank:
_______________________
Time in Business: ___ Contact Name: __________
Account #: ___________________________
Business Fed Tax ID #: ______________________ Phone Number:
_______________________
Business Description: _______________________ Contact
Name: _______________________
Type of Business: Corporation __ LLC__ S-Corp__ Proprietorship__
Partnership__ Non-Profit __ |
EQUIPMENT TO BE LEASED / FINANCED (attach equipment schedule if
necessary)
Address where Equipment will be kept:
______________________________________________
Quantity: ___ Year: _____ Make: _________________________ Model:
___________________
Equipment Description:
___________________________________________________________
Purchase Price: ______________ Proposed Terms: Number of Months:
_______ |
PERSONAL INFORMATION on OFFICERS, PARTNERS or OWNERS
Name:_____________________________________ Social Security
Number: _______________
Home Address: _____________________________________ City:
________________________
State: _____ Zip: _________ Home Phone #: __________________ %
of Ownership: _________
Name:_____________________________________ Social Security
Number: _______________
Home Address: _____________________________________ City:
________________________
State: _____ Zip: _________ Home Phone #: __________________ %
of Ownership: __________ |
By signing below, the undersigned individual, who is either a
principal of the credit application or a personal
guarantor of
its obligations, provides written instructions to Lessor, or its
designees (and any assignee or
potential assignee thereof)
authorizing review of his/her personal credit profile from a
national credit bureau.
Such authorization shall extend to
obtaining a credit profile in considering this application and
subsequently
for the purposes of update, renewal or extension of
such credit or additional credit and for the reviewing or
collecting the resulting account. A photostat or facsimile copy
of this authorization shall be valid as the
original by
signature below. I/we affirm my/our identity as the respective individual(s) identified in the above
application. I authorized
all deposit, borrowing and trade information to be released to
the Lessor. I hereby
represent all information is true, correct
and complete. |
Signature: ______________________________ Signature:
______________________________
Print Name: ____________________________ Print Name:
____________________________
Date: __________________ Date: __________________ |
The Federal Equal Credit Opportunity Act prohibits 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’s 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 is the Federal Trade Commission Equal Credit
Opportunity, Washington, D.C. 20580. If your application for
business credit is denied, you have the right to a written
statement of the specific reasons for the denial. To obtain the
statement, please contact Lessor set forth above within 60 days
from the date you are notified of our decision. We will send you
a written statement of reasons for the denial within 30 days of
receiving your request for this statement. |
Application
Trade References:
1. Company Name:
______________________________________________________________
Address:
______________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________
2. Company Name:
______________________________________________________________
Address:
______________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________
3. Company Name:
_____________________________________________________________
Address:
_____________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________
Debt References (Installment loans, leases, etc.):
1. Company Name:
______________________________________________________________
Address:
______________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________
2. Company Name:
_____________________________________________________________
Address:
_____________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________
3. Company Name:
_____________________________________________________________
Address:
_____________________________________________________________________
Contact:
______________________________________________________________________
Phone:
_______________________________________________________________________ |
Date: _________________
Attention: _______________________________________
_______________________________________
_______________________________________
Re:
_______________________________________
_______________________________________
_______________________________________
Dear Sir/Madam:
We have given you as a credit reference to Yandell and Company.
Please accept this letter as authorization to release any and
all information regarding our accounts we have with you to
Yandell and Company, or its assigns. We acknowledge a photostat
or facsimile copy of this authorization shall be valid as the
original by signature below.
Your prompt response is greatly appreciated.
Very truly yours,
_____________________________________________
Company Name
_____________________________________________
Print Name
_____________________________________________
Authorized Signature |
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685 West End Avenue Suite 15A New York, NY
10025 617-735-9188/ 617-812-8448 fax |
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* Please print, fill it out and fax it back
to 617-812-8448 |
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