Cash Application

Business Information

Doing Business As

Corporation/Legal Name

Business Address

City

State

Zip Code

Mailing Address(Check box if same as above)

City

State

Zip Code

Contact Name

Phone Number

Fax Number

Cell Phone Number

Email Address

Type of business

Federal Tax ID

State

Average Monthly Visa/Master Card

Average AMEX

Gross Annual Sales

Do you Have a cash Advance?

With Whom?

Balance

Type of Entity

Sole Proprietorship Corporation Partnership

LLC LLP Non Profit

Business Facility:

Rent Own

Monthly/year Business Established

Length of Ownership

Year Months

Monthly Rent/Mortgage

Length Remaining on Lease

Year Months

Contact Name

Phone Number

Fax Number

Ownership Information

1st Owner's Name

Title

Home Address

City

State

Zip Code

Phone Number

Cellular Phone Number

Date of Birth

Driver's License Number

State lssued

Social Security Number

Percent Ownership %

2nd Owner's Name

Title

Home Address

City

State

Zip Code

Phone Number

Cellular Phone Number

Date of Birth

Driver's License Number

State lssued

Social Security Number

Percent Ownership %

Bank Information

Bank Name

Phone Number

City

Routiong Number

Account Number

Leasing App

Legal Business Name

City1

State

Zip

Phone

Contact

Type of Business

Years in Business

OWNER INFORMATION

Prop Corp ptash

Federal Tax ID #

Officer Name

Title

SS#

City

State

Zip

%of Ownership

Officer Name

Title

SS#

City

State

Zip

%of Ownership

VENDOR

Contact

Phone

Equipment

Cost

Term 36 48 60

BANK

Bank

Contact

Account # Business Checking

Phone

Other Banking Refrence

TRADES

Name

Contact

Phone

Name

Contact

Phone

Name

Contact

Phone

1 Penn Plaza, New York 10119 info@prestigeinvestmentsusa.com (646) 233-0685

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Jeff

Excellent company that has come through for me several times.

Jeff,

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