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CREDIT APPLICATION
Please note that the BOLD fields are required. Please print and fax to (386)671-6004.

LESSEE INFORMATION
CORPORATE NAME
DBA
ADDRESS
CITY
STATE
ZIP -
PHONE -             
FAX -
E-MAIL
CONTACT PERSON

VENDOR INFORMATION
NAME
ADDRESS
CITY
STATE  
ZIP -
PHONE -
FAX -
CONTACT PERSON

EQUIPMENT
DESCRIPTION
LOCATION ( IF DIFFERENT FROM ABOVE )
TOTAL PRICE WITHOUT TAX $
LEASE TERM (MONTHS)
MONTHLY PAYMENT $
NO. ADVANCE  RENTALS

DATA
FEDERAL TAX ID
LEGAL STRUCTURE OF BUSINESS CORPORATION
PROPRIETORSHIP
PARTNERSHIP
NON-PROFIT
LLC
TYPE OF BUSINESS 
YRS. EST
STATE INC.
NAME OF PRINCIPLE OF FIRM
ADDRESS
OWNERSHIP %
TITLE
SOC. SEC. #
HOME TEL -

BANK REFERENCES (Prior Bank required if less than two year history) ONLY  BUSINESS  CHECKING  AND   LOAN  ACCT. ADMISSIBLE
(1) BANK NAME
ADDRESS
PHONE -
BANK OFFICER
ACCOUNT#
(2) BANK NAME (prior bank)
ADDRESS
PHONE -
BANK OFFICER
ACCOUNT#

TRADE REFERENCES (MUST LIST AT LEAST THREE REFERENCES)

Reference #1
TO WHOM PAID
CITY/STATE
PHONE -
ACCOUNT NO.
CONTACT

Reference #2
TO WHOM PAID
CITY/STATE
PHONE -
ACCOUNT NO.
CONTACT

Reference #3
TO WHOM PAID
CITY/STATE
PHONE -
ACCOUNT NO.

CONTACT

Please Read Carefully:

In considering this request from you, we will rely heavily on the information which you have supplied. It is most important that the information be accurate and complete. It is a federal crime to make a false statement on this application. By submitting this application, you represent and warrant the accuracy of the information and you acknowledge having read the Fair Credit Reporting Act disclosure, which is printed below.

Fair Credit Reporting
In connection with the administration of loans and leases, SFR Funding, Inc., may request a routine investigative consumer report concerning my character, general reputation, personal characteristics and mode of living, whereby information is obtained through interviews with neighbors, friends or others with whom I'm acquainted. If such a report is requested, detailed information about the nature and scope of this investigation will be made available to me upon my written request within a reasonable period of time.

Credit Information Release
SFR Funding, Inc., will be requesting information by telephone and fax on all bank accounts and trade references submitted above. Please accept this release as authorization to provide the requested information.