LESSEE (Complete name of legal entity. If a corporation, use EXACT registered corporate name.)
Company Name
 
DBA Name
Years in Business
 
Date
03/09/2010
Billing Address
City
County
State
Zip
Telephone No.
 
Fax No.
Email
Retype Email
 
Nature of Business
Contact
Contact Telephone No.
PRINCIPAL OFFICERS
Name
% Ownership
 
Title
SSN
Date of Birth
 
Mailing Address
Street
City
State
Zip
Phone
Email
Retype Email

 
Name
% Ownership
 
Title
SSN
Date of Birth
 
Mailing Address
Street
City
State
Zip
Phone
Email
Retype Email

 
Name
% Ownership
 
Title
SSN
Date of Birth
 
Mailing Address
Street
City
State
Zip
Phone
Email
Retype Email

 
Bank Checking Acct.
(Minimum 2 yrs. history)
Telephone No.
Account No.
Contact
Trade Reference
(Minimum 2 yrs. history)
City
State
Telephone No.
Contact
Current or Past
Lease/Loan References
Loan Account No.
City/State
Telephone No.
Contact
Supplier Information
Name of Supplier
Sales Rep.
Telephone No.
Fax No.
Lease Payment Terms
Term in Month
Lease Payment
 
Advance Deposit
 
Factor
Purchase Option
Type of Equipment
Equipment Cost
 

I/we hereby authorize you to whom this application is made, or your assigns, to investigate my/our credit worthiness and will provide financial statements, tax returns, etc., as you deem necessary.



CEF LLC, Inc. will review the information carefully and get back to you promptly. 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 that statement, please contact us within 60 days from the date that you are notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of your request for the statement. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors 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.