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1 Credit Application 4165 Half A cre Road, Batavia OH 45103 Phone 513-‐373-‐4991 / Fax 513-‐298-‐0272 Contact: Chris Lyle Email: [email protected] Tell us about your purchase Vendor Equipment Description Purchase Price Auxiliary Equipment Down-‐Payment Finance Amount $ 0.00
Financing Structure Term in Months: 24 ❏ 36 ❏ 48 ❏ 60 ❏ 72 ❏
Vendor Payment Terms Delivery Date Will the equipment be subleased? Yes ❏ No ❏ Company Name (“Applicant”) Address State Zip County Contact E-‐mail Address Physical Location of Equipment 2 ■
84 ❏
or Other ❏ Tell us about your business Phone Fax Contact Fed. Tax ID No. In Business Since Current Ownership Since Fiscal Year End Sales Tax Exempt? Yes ❏ No ❏ If yes, attach exemption certificate 3 State of Inc. City ■ LLC ❏ S-‐Corp ❏ Proprietorship ❏ Partnership ❏ Corporation ❏
Tell us about your owners 1. Name/ Title % of Ownership SS No. Birthdate Home Address 2. Name/ Title % of Ownership SS No. Birthdate Home Address If there are more than 2 owners, please use a 2nd Application to provide additional Information. Are there any suits, judgments or tax liens against the Applicant or any of the above principals or has the Applicant or any of the above principals ever declared bankruptcy? Yes ❏ No ❏ If yes, explain on a separate page. 4 Tell us about your bank Bank Name City, State, Zip Account No. Type of relationship Length Bank Officer Telephone No Fax No. Email Applicant hereby authorizes Equipment Finance Group, LLC, Milacron Marketing Company, LLC ("Creditors") and any agents or assignees, for Applicant and each individual listed as a principal, partner, owner, guarantor, or obligor: (1) to obtain more commercial and consumer credit information, including credit reports, about Applicant and its principals and such individuals listed and to make inquiries in connection with this Application; (2) to share such credit information with affiliates of Creditors' or its' assignees, as well as Applicant's other creditors, bureaus, and persons who have or expect to have financial dealings with the Applicant or its principals and such individuals stated above and to use such shared information to market to Applicant and such individuals; and (3) to share collection information with Applicant's and such individuals other creditors. All the information in this Application is true, complete and correct. This Application will apply to any future request, unless the Applicant submits a new written application. Creditors do not make offers or commitments to extend credit except in final signed documents and, in limited circumstances, in and pursuant to the terms and conditions of written commitment letters. Term sheets, proposal letters and the like are not commitment letters. 5 Authorization X. Signature X. Signature Name Title Date Name Title Date IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. The Applicant hereby represents and warrants that, if an individual, the Applicant is a citizen or lawful permanent resident of the United States. The person signing below on behalf of Applicant and such individuals listed above are authorized to make this Application on its behalf and to agree to the foregoing, and also has the authority to act for Applicant's principals, co-‐owners, and individuals listed above, in instructing Creditors and its agents and/or assignees to obtain credit reports on them. Equipment Finance Group LLC
4165 Half Acre Road
Batavia, OH 45103
513-373-4991
513-298-0272
www.EFGLLC.com
Fax
To:
Chris Lyle
Sending Company:
Fax:
513-298-0272
From:
Phone: 513-373-4991
Pages:
Email:
[email protected]
Date:
Re:
Credit Application
cc:
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