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Credit Application

Business Information: 

     Business Name:
     Nature of Business:
     Address: 
     City:
     Telephone (area code first):
     Fax:
     Federal Tax ID:
      Number of Employees:
     Web Address:
     Email Address:


         

  State:   Zip:  
() 
() 




Equipment Information

     Desired Term of Lease:
     Amount:    

                                                           

   

Equipment Description:    

                                                                                                    

How much monthly revenue do you estimate the equipment will generate?

  

  Owners:

    Type of ownership:                                     
   Time in business under current ownership:    

   Have any owners filed bankruptcy in the last 10 years?   
   (This alone will not disqualify your application)

   Owner #1:  

     First Name:
     Title: 
     Social Security Number: 
     % of Ownership: 
     Home Address:
     City:
     Home Telephone:
     Mobile Phone:

    Last Name: 



   
    State:      Zip: 
() 
() 

   
   Owner #2:  

     First Name:
     Title: 
     Social Security Number: 
     % of Ownership: 
     Home Address:
     City:
     Home Telephone:
     Mobile Phone:

    Last Name: 




    State:      Zip: 
() 
() 

  
   Owner #3:  

     First Name:
     Title: 
     Social Security Number: 
     % of Ownership: 
     Home Address:
     City:
     Home Telephone:
     Mobile Phone:

    Last Name: 



   
    State:      Zip: 
() 
() 

  

How would you describe the credit history of each owner (if known)?  Please choose from the drop down   
   menu which corresponds with each owner:   

Owner #1:
Owner #2:
Owner #3:


Upon submission of this form, the applicant(s) represents that all information provided with this Application is true and correct and hereby authorizes Cooperative Capital to obtain from third parties information Lessor deems necessary to arrive at a decision regarding this Application.  By submitting below, the applicant(s), authorizes Cooperative Capital, its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this Application and for the purpose of the update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts.  (Please note that we need a credit authorization for each individual listed above in the Owners section.

 

 


 

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