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Commercial Finance Application
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Applicant Information

Business Name:

Person to Contact:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Email Address:

Type of business:

Business Start Date:

(mm/dd/yy)

Federal Tax ID#:

Resale #:

Legal Structure:

Dealer/Vendor Information

Dealer/Vendor Name:

 Joseph Thompson & Associates, LLC

Contact:

 Joe Thompson

Address:

City:

 Madison

State:

 WI

Zip:

Phone:

Fax:

Email Address:

 thompsonjp@sbcglobal.net

Location of Equipment

Address, City, State, Zip
(if not the same as the applicant address:)

Officers or Owners (1)

First Name:

Last Name:

% of Ownership:

Title

Home Address:

City:

State:

Zip:

Phone:

SSN:

Officers or Owners (2)

First Name:

Last Name:

% of Ownership:

Title

Home Address:

City:

State:

Zip:

Phone:

SSN:

Officers or Owners (3)

First Name:

Last Name:

% of Ownership:

Title

Home Address:

City:

State:

Zip:

Phone:

SSN:

Bank References (1)

Bank Name:

Account Number:

Bank Contact:

Bank Phone:

Bank Fax:

Type of Account:

Bank References (2)

Bank Name:

Account Number:

Bank Contact:

Bank Phone:

Bank Fax:

Type of Account:

Credit References (1)

Firm Name:

Account Number:

Contact:

Phone:

Fax:

Credit References (2)

Firm Name:

Account Number:

Contact:

Phone:

Fax:

Credit References (3)

Firm Name:

Account Number:

Contact:

Phone:

Fax:

Equipment and Terms

Equipment Description:

Equipment Cost:

Preferred Lease Term:

Buyout Option: