Pre-Qualifying Application

Solaris Energy, Inc.

Pre-Qualifying Application

Applicant Information
Applicant Company/Full Legal Name*
Company type
State of Formation/Incorporation*
Company Tax ID #*
i.e. FEIN, EIN, SSN (numbers only, no dashes)
Website
Applicant Entity Company Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Main Point of Contact
Full Name*

First NameLast Name
Email*

Confirmation EmailEmail
Phone Number*
Phone Number

Financial Information
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Financial Information

Please provide as much information as you are able. Additional documentation will be requested for full approval.
Last Three Years & Year-to-Date Profit and Loss Statements of Company Paying Electric Bills*

Cancelof
Last Three Years & Year-to-Date Balance Sheets of Company Paying Electric Bills*

Cancelof
Company Credit Report (if available)

Cancelof
Last 12 Months of Property Electric Bills (if not already provided)

Cancelof
Any additional comments or notes (passcodes to access documents, explanations of financials, etc.)

Terms & Submission
The above information and any information attached is furnished to Seller and its Financing Parties in connection with the Application of credit for which you may apply or credit you may guarantee. You acknowledge and understand that the Seller is relying on this information in deciding to grant or continue credit or to accept a guarantee of credit. You represent, warranty and certify that the information provided herein is true, correct and complete. The Seller is authorized to make all inquiries deemed necessary to verify the accuracy of the information contained herein and to determine your creditworthiness. You authorize any person or consumer-reporting agency to give the Seller any information it may have about you. You authorize the Seller to answer questions about its credit experience with you. Subject to any non-disclosure agreement between you and Seller, this form and any other information given to the Seller shall be the Seller’s property. If your application for business credit is denied you have the right to a written statement of the specific reason for the denial. To obtain the statement, please contact Seller at (970) 279-3137. You must contact us within 60 days from 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.
Printed Name
Title
Signature*

Clear
Please verify that you are human*
Solaris Energy, Inc.

430 North College Ave., Suite 440, Fort Collins, CO 80524

970.279.3137

www.SolarisEnergy.com
SAVE INSTRUCTIONS: If you choose to save this form before submitting you do NOT have to create a Jotform account. At the bottom of the pop-up screen, you will see an option link to "Skip Creating Account" - once clicked you can email yourself a link to edit the saved form.
Should be Empty:

Solaris Energy, Inc.

Financial Information