Services-Form – Tricon Leasing

COMPANY:

Company Name:

Phone Number

Full Address with zip:

Contact Name

ZIP

Title

Phone:

* Email Address:

Cell Phone:

BUSINESS INFORMATION:

Years in Operation:

Nature of business:

Federal ID#

President/CEO

PRINCIPAL INFORMATION:

Primary Owner’s Name:

Percentage of ownership:

Home phone:

Social:

Title:

Full home address:

Other Owner’s Name (if applicable):

Percentage of ownership:

Home phone:

Social:

Title:

Full home address:

Give brief reason for the financial request:

BANK INFORMATION:

Name of Bank:

Phone No.

Contact:

Checking Number:

Loan # if Applicable:

AUTHORIZATION TO RELEASE INFORMATION:

I hereby certify the information given and contained in this application is true and accurate to the best of my knowledge. I further authorize all loan, borrowing or other account information to be given or made available to TRICONLEASING GROUP and or its assigns in processing this request for financing, all parties deemed to be held harmless in any judicial matter of inquiry or litigation thereto.

Company name:

Today’s date:

APPLICANT SIGNATURE BELOW

Print Name:

Title:

Print Name:

Title:

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