240 Tech Credit Application
Shirley Carlisle | 714-227-3951 | Shirley@240tech.com
CUSTOMER INFORMATIOM
Company Name OR Individual Last, First and Middle Name, Suffix
*
DBA
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Fax Number
Contact Email
*
example@example.com
State Organization ID #
*
Federal Tax ID #
*
BUSINESS TYPE
Business Type
*
Sole Proprietorship
Limited Liability Company
Limited Partnership
S Corporation
General Partnership
C Corporation
State Of Business Incorporation
*
Date Established
-
Month
-
Day
Year
Date
Years in Business (Present Ownership)
*
Nature of Business
*
EQUIPMENT AND VENDOR INFORMATION
Equipment Group Installation Address (If different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please see attached quote for equipment, vendor details, and financing amount.
PAYMENT PLAN
Lease Terms (months)
*
24 months
36 months
48 months
60 months
Lease Structure
*
FMV
10% PUT
$1 OUT
Fixed Purchase
FMV or %
BANK REFERENCES
2 Year History
1. Bank Name
*
Contact Name
*
City
*
State
*
Lease/Loan Acct. #
*
Lease/Loan Original Date
*
-
Month
-
Day
Year
Date
Lease/Loan Original Terms (months)
*
Checking Acct. #
*
Telephone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
2. Bank Name
Contact Name
City
State
Lease/Loan Acct. #
Lease/Loan Original Date
-
Month
-
Day
Year
Date
Lease/Loan Original Terms (months)
Checking Acct. #
Telephone #
Please enter a valid phone number.
Format: (000) 000-0000.
OWNERS, PARTNERS, AND GUARANTORS
1. Name
First Name
Last Name
Title
% Ownership
Owner Since
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Telephone #
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
2. Name
First Name
Last Name
Title
% Ownership
Owner Since
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Telephone #
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
3. Name
First Name
Last Name
Title
% Ownership
Owner Since
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Telephone #
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
Signature
*
Print Name
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: