Vendor Information Form Small Business Equipment Financing

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For Equipment Sellers

ACCOUNT INFORMATION

Company Name:
DBA:
Email:
Address:
City:
State:
Zip:
Telephone #:
Fax #:
Fed Tax ID #:
Resale #:
Type of Business:
Years Under Present Ownership:
D & B Rating:
Leasing Coordinator / Contact:
Principle Owner Name:
Home Address:
City:
State:
Zip:
Home Telephone #:
SSN:

PRIMARY COMPANY BANK REFERENCE (2 YR. HISTORY)

Name of Bank/Branch:
Address:
City:
State:
Zip:
Telephone #:
Contact:
Acct #:

PRODUCT LINES (EQUIPMENT TO BE LEASED)

Describe Equipment:
Primary Vendor / Supply Company:
Address:
City:
State:
Zip:
Telephone #:
Contact:
Acct #:

I hereby authorize SunState Capital to contact the above named references and to obtain information necessary to verify our financial and service background. I hereby authorize any photocopies of the release to be provided to references above.