Business Applicant Information

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    Business Applicant Information

    Legal Business Name*

    Federal ID*

    State Of Incorporation*

    Trade Name (If Different)

    Date Entity Formed (mm/dd/yyyy)*

    Business Structure*

    Business Main Address

    Address Line 1*

    City*

    ZIP / Postal Code

    Address Line 2

    State / Province / Region*

    Country*

    Business Primary Contact

    Name*

    Business Contact Email

    Business FAX

    Business Phone

    Business Secondary Phone

    Primary Owner Information

    Full Name*

    Social Security Number*

    Business Title*

    Address Line 1*

    City*

    ZIP / Postal Code

    Phone Number

    Secondary Phone Number

    Ownership %*

    Address Line 2

    State / Province / Region*

    Country*

    Officer / Partner Information

    Full Name

    Social Security Number

    Business Title

    Address Line 1

    City

    ZIP / Postal Code

    Phone Number

    Secondary Phone Number

    Ownership %

    Address Line 2

    State / Province / Region

    Country

    Bank Information

    Bank Name*

    Bank Contact Name

    Bank Phone Number*

    Bank Account Number*

    Bank Contact Email

    Bank Fax Number

    Trade Information

    Trade Business Name*

    Trade Contact Name*

    Trade Phone Number*

    Trade Account Number

    Trade Contact Email*

    Trade Secondary Phone

    Vendor Information

    Sales Rep Name*

    Sales Rep Phone*

    Equipment Type*

    Sales Rep Email*

    Business Secondary Phone

    Equipment Cost*

    Statement

    By signing this document you authorize Par Finance Corporation (“PFC”) or its assigns to obtain a copy of your credit report and to request, verify and review data or information about applicant’s officers, partners, owners and guarantors including reports from agencies and information from references. All information provided herein is correct and complete. If business credit is denied, customer has the right to a written statement of the reasons for the denial. To obtain a statement please contact PFC within 60 days of denial.

    Name and Title *

    Signature (Print Name)*

    Date (mm/dd/yyyy)*

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