Company Name: __________________________ Phone number: _____________________

Address : __________________________________________________________________

City, State, Zip: _____________________________________________________________

Fax number: _____________________ email: _____________________________________

Contact: ___________________ Title:___________ Nature of Bus:____________________

Type of business Corp: ______ (Yr. Inc'd _____) Proprietorship _____ Partnership ____ Mo/Yr in bus. under current ownership ___________

Have you ever filed for Bankruptcy? ____ If so, what year _____
Do you have any outstanding liens or judgments? ______

PRINCIPAL/GUARANTOR
(include any other owners/guarantors at the bottom or on a separate sheet)

1st Name: ________________________________________ Title: ____________________

Social Security Number:______/____/________ % Ownership: _______________________

Home Address: _____________________________________________________________

City, State. Zip: _____________________________________________________________

Home phone number: ________________________________

2nd Name: ____________________________________ Title:________________________

Social Security Number:______/____/________ % Ownership: _______________________

Home Address: _____________________________________________________________

City, State. Zip: _____________________________________________________________

Home phone number: ________________________________

Name of Bank: _____________________________________________________________
Checking Acct #_____________________ Loan Acct#___________________
Phone # _________ Contact ____________________
please provide us with additional bank information if applicable

Trade/Lease References:
City/State ______________________________________ Phone# _________________
Customer Acct #__________________________
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________

Vendor Information:
Vendor Name: ______________________________________________________________
Contact _________________________________ Phone# ___________________________
Equipment Description: __________________________ Cost $_______________________

Leasing Terms Requested:

Option #1 _____ months  Option #2 _____ (example: 24, 36, 48 or 60 mo.)
 

I hereby certify that the information contained in the application is true and accurate to the best of my knowledge and authorized all deposit, borrowing and credit bureau information to be released by phone or Fax. The undersigned individual who is either the principal, a persona guarantor or a sole proprietorship of the credit application, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant(s), hereby consents and authorizes Log-Master or its designee the use of a consumer credit report on the undersigned, from time to time as may be needed.

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