PFC CREDIT APPLICATION
Send application to:
PrimeCo Financial Corporation
2530 Seaview Avenue, 3rd Floor, Suite 5
Corona Del Mar, CA 92625
Phone: 800-405-1450 Fax: 800-858-6336
Attention:
LESSEE COMPANY INFORMATION
Company Name
Company Address
City
State
Zip
Signer
Title
Telephone
-
-
Type of Business
Years in Business
Proprietorship
Partnership
Corporation
LLC/ LLP
PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS
Name
Title
Social Security Number
% Ownership
-
-
Home Address
City
State
Zip
Home Phone
-
-
Name
Title
Social Security Number
% Ownership
-
-
Home Address
City
State
Zip
Home Phone
-
-
Has any applicant or guarantor ever had:
Repossession
Judgment
Bankruptcy
None
COMPANY BANK RECORDS - FIVE YEAR HISTORY
Name of Bank/Branch
How Long?
Chkg. Account #
Telephone Number
Contact Officer
-
-
Name of Bank/Branch
How Long?
Chkg. Account #
Telephone Number
Contact Officer
-
-
TRADE REFERENCES - TWO YEAR HISTORY
Name of Supplier
City/State
Telephone Number
Contact Person
-
-
Name of Supplier
City/State
Telephone Number
Contact Person
-
-
LEASE/LOAN REFERENCES
Name
Amount
Acct #
Telephone Number
Contact Person
-
-
EQUIPMENT DESCRIPTION
DECLARATION
APPLICANTS STATEMENT: By signing below, Applicant agrees that: They are in fact authorized to provide this information; Applicant(s) have answered the questions fully and truthfully. Applicant(s) understand that PrimeCo Financial Corp. ("PFC") may check Applicant(s) credit record and any statements Applicant(s) have made. If any of the information provided herein is inaccurate, falsely conveyed, or materially incomplete, then any fees collected as a result of reliance upon this application shall be deemed forfeited to PFC. Applicant(s) give all of its creditors permission to give PFC any information needed to determine whether PFC wants to grant Applicant(s) credit.
Signature
Date