APPLICATION TO ENTER INTO A SECURITY AGR
EEMENT WITH THE COMMERCIAL FINANCE GROUP
1. BUSINESS NAME: ___________________________________________
2.. DBA:
3. ADDRESS: ______________________________________________
5. CITY, STATE, ZIP: ______________________________________________
7. PRODUCT OR SERVICE: _______________________________________
13. COMPANY OWNERS AND / OR OFFICERS - Personal and residence information:
NAME:
Title % Co. Ownership Telephone
Address:
City, State, Zip Own Rent
Driver License # and State:
Soc. Sec. #: DOB
NAME:
Title % Co. Ownership Telephone
Address:
City, State, Zip Own Rent
Driver License # and State:
Soc. Sec. #: DOB
NAME:
Title % Co. Ownership Telephone
Address:
City, State, Zip Own Rent
Driver License # and State:
Soc. Sec. #: DOB _____________
Contact:
Telephone:
14. RECEIVABLES: Open:
15. SALES VOLUME: Average Monthly: $
16. BANK INFORMATION, Business
Bank or S & L Name:
Account Number:
17. BANK INFORMATION, Personal, Primary Owner / Officer
Bank or S & L Name:
Telephone:
Checking Account Number:
Savings Acct. Number: Contact:
No How Often: Last One:
No:
18. PROFESSIONAL INFORMATION:
Name and phone number of Attorney:
Name and phone number of Accountant:
Regular Financial Statements prepared: Yes
Copy of Financial Statement attached (Essential): Yes:
Customers buying from “Contra” Account position (bartering)?
9. STATE WHERE FILED:
10. TY
PE OF COMPANY:
C-corp S-Corp Partnership LLC
Sole Proprietor
11. IF PROPRIETORSHIP / PARTNERSHIP OR USING A DBA, county Fictitious Business Name Statement filed in?
12. HOW DID YOU FIND U
S?
4. PHONE:
6. FAX:
8. YEAR ESTABLISHED:
COUNTY:
APPLICATION TO ENTER INTO A SECURITY AGREEMENT WITH THE COMMERCIAL FINANCE GROUP
State Tax Number: Local Tax Number:
Phone Number:
Contact:
Phone Number:
19. TAX NUMBERS AND INFORMATION:
Federal Tax Number:
20. PRINCIPAL SUPPLIERS:
Company:
Company:
Company:
Contact:
Phone Number:
21. ASSETS ASSIGNED, PLEDGED, LIENED, OR AS COLLATERAL FOR LOANS:
ACCOUNTS RECEIVABLE: Yes:
No: To Whom: Address:
City, State, Zip:
Telephone:
INVENTORY: Yes:
No: To Whom: Address:
City, State, Zip:
Telephone:
EQUIPMENT: Yes:
No: To Whom: Address:
City, State, Zip:
Telephone:
FIXTURES: Yes:
No: To Whom: Address:
City, State, Zip:
Telephone:
OTHER: Yes:
No: To Whom: Address:
City, State, Zip:
Telephone:
By executing this appli
cation, the undersigned (the “Applicant”) certifies to the following: (1) The information set forth in this application and in
the
documents,
schedules,
reports,
statements,
and/or
other
information
provided
to
THE
COMMERCIAL
FINANCE GROUP with or pursuant to
this
application
are
full,
true,
correct,
and complete and accurately reflect such information on the date(s) thereof; (2) that
THE COMMERCIAL
FINANCE GROUP may share this application and any supporting documentation with its agents, representatives, affiliates and designees
(collectively, “Assignees”), and THE COMMERCIAL FINANCE GROUP and its Assignees are authorized to request,
receive, and verify credit
reports and other financial
information regarding applicant and its business that THE COMMERCIAL FINANCE GROUP or its Assignees deem
necessary and appropriate; and (3) that THE COMMERCIAL FINANCE GROUP and its Assignees are authorized to inquire of, investigate,
confirm,
and verify any information contained
in this application, in any documents, schedules, reports, statements, and/or other information
provided under or pursuant to this application, or learned by THE COMMERCIAL FINANCE GROUP or its Assignees as part of its investigation
and review of this application, applicant, or applicant’s business. Please be aware that an electronic signature is as legally binding as a handwritten
signature. A document is considered signed when
returned by an electronic form of written communication, i.e.: email. Applicant waives and
releases any claims
against THE COMMERICAL FINANCE GROUP, any Assignees and any information providers relating to the requesting,
receiving or release of the information obtained in connection with this application.
Dated: Signed: X Title: __
Dated:
Signed: X Title: __
Dated:
Signed: X Title: __
Contact: