Business Partner Profile
HARRIS LEASING COMPANY * P.O. BOX 42203 * HOUSTON, TEXAS 77242
www.harrisleasing.com 713-783-7820 (TEL), 713-783-7813 (FAX)
CORPORATE NAME:______________________________ DBA: ____
ADDRESS, CITY, STATE/ZIP: ____
CONTACT/ S: __________
WEB ADDRESS: _______
E-MAIL ADDRESS: __________
PHONE: _
FAX:
NATURE OF BUSINESS: ____
PRODUCT(S) SOLD: ___________
Yrs. in Business:
PROP: PART: CORP: NP:
(IF CORP, State of Incorporation
Charter No. _________________________)
BANK REFERENCES (Company and/or Personal – If account is less than 2 yrs. please show previous banking)
Bank Name Phone # Officer’s Name Account / Loan #’s
1.
2.
SUPPLIERS
Name Phone # Contact Account #
1.
2.
3.
4.
BUSINESS LANDLORD (Or Mortgage Holder)
Name Contact Phone #
1.
PERSONAL CREDIT INFORMATION IS REQUIRED FOR ALL COMPANIES LESS THAN 2 YEARS IN BUSINESS
OWNER(S)/OFFICER(S)
Full Name: % of Ownership:
Home Address/Zip: Years at Present Address:
Home Phone # Alternate Phone #
Social Security # DOB Driver’s License #
Full Name: % of Ownership:
Home Address/Zip: Years at Present Address:
Home Phone # Alternate Phone #
Social Security # DOB Driver’s License #
AUTHORIZATION:
I/WE ,
, AUTHORIZE ANY CREDIT AGENCY, BANKS AND TRADE
REFERANCE TO RELEASE TO HARRIS LEASING COMPANY ANY INFORMATION REQUESTED CONCERNING PERSONAL OR
COMPANY CREDIT STANDING. THIS INFORMATION MAY BE RELEASED OVER THE TELEPHONE, IN WRITING, OR BY FAX. I/WE
HEREBY FURTHER AUTHORIZE ANY PHOTOCOPY OF THIS RELEASE.
SIGNATURE/TITLE: DATE:
SIGNATURE/TITLE:
DATE:
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