Bush Specialty Vehicles: Business Application

CUSTOMER INFORMATION

Firm Name (Correct Legal Name)

IncorporatedPartnershipProprietorship

Fed. Employer ID # (FEIN)

Physical Street Address

City

State

Zipcode

Billing Address

City

State

Zipcode

Email Address

Phone

Years in Business

Home Status

Mortgage Lendor	Mortgage Balance	Years Lived at Address	Months lived at address
Landlord Name	Monthly Rent	Years Lived at Address	Months lived at address

TRADE REFERENCES

1 Name	City	State	Phone
2 Name	City	State	Phone
3 Name	City	State	Phone

FINANCIAL REFERENCES

BUSINESS CHECKING ACCT:

Bank

City

State

Phone

Account #

LOAN REFERENCES:

1 Company	City	State	Phone	Account #
2 Company	City	State	Phone	Account #
3 Company	City	State	Phone	Account #

APPLICANT GUARANTOR INFORMATION

1 Owner / President / Partner NAME

Date of Birth

Social Security Number

Percent owned

Home Address

City

State

Zipcode

Phone

2 Owner / President / Partner NAME

Date of Birth

Social Security Number

Percent owned

Home Address

City

State

Zipcode

Phone

Type(s) of Equipment to be Leased

Term Requested (months)

TO THE BEST OF MY / OUR KNOWLEDGE, THE ABOVE INFORMATION IS TRUE AND ACCURATE

CUSTOMER SIGNATURE(S)

I/We affirm my/our identity and authorize Bush Truck Leasing, Inc. and/or its Lenders/Corporate Sponsors to investigate my/our credit history. Upon request from Bush Truck Leasing, I/we authorize any credit grantor to release to Bush Truck Leasing, Inc. and/or its Lenders/Corporate Sponsors, my/our credit record. A Photostat or facsimile of this authorization shall be as valid as the original.

Please click signature field, indicating the above information is correct. Checking of this field indicates your approval and acts as a signature.
SIGNATURE