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FINANCING

To apply for financing, simply fill out the application below and we will contact you.

Company Information:

COMPANY NAME:
	(Full Legal Name Including DBA if Applicable)
COMPANY STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
CONTACT:
PHONE:
FAX:
E-MAIL:
TYPE OF BUSINESS:
YEARS CURRENT OWNERSHIP:	(min. 2 years in business)
FEDERAL TAX ID NO.
DATE EST	(MO/YR)
NUMBER OF EMPLOYEES:
INSURANCE NAME:		PHONE:
	(with address & contact)
LANDLORD'S NAME:		PHONE:
	(for other equipment installed)

Principal Information

PRINCIPAL'S NAME:	(first, middle, last)	TITLE:
% OF OWNERSHIP:		SOS:
HOME ADDRESS:	OWN RENT	PHONE:

PRINCIPAL'S NAME:		TITLE:
% OF OWNERSHIP:		SOS:
HOME ADDRESS	OWN RENT	PHONE:

Vendor Information

VENDOR NAME:		PHONE:
WEB SITE/SOFTWARE/EQUIPMENT:		COST:
CONDITION:	NEW USED

Lender Information

BANK/LENDER NAME:		BRANCH:
OFFICER:
PHONE:		ACCOUNT NO.:

ACCOUNT TYPE:

LEASE LOAN SAVINGS CHECKING

NAME ON ACCOUNT:		DATE OPENED:
BALANCE:

BANK/LENDER NAME:		BRANCH:
OFFICER:		PHONE:
ACCOUNT NO.

ACCOUNT TYPE:

LEASE LOAN SAVINGS CHECKING

NAME ON ACCOUNT:		DATE OPENED:
BALANCE:

Trade References

TRADE REFERENCE:		PHONE:
ACCT. # AND CONTACT:

TRADE REFERENCE:		PHONE:
ACCT. # AND CONTACT:

TRADE REFERENCE:		PHONE:
ACCT. # AND CONTACT:

Release

To Whom It may Concern:
I understand that submission of this form is your authority and my request for you to release any information requested concerning personal or company credit standing.

For further information about YellowZone, Inc., contact us at (818) 788-7810. Email us at