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Application
Apply Today
1
Business Information
2
Principals
3
Trust Information
4
Support Information
5
Tax Information
6
Banking Information
7
Machinery & Equipment
Collateral Information
8
Signatures
Legal Business Name:
*
Phone:
*
Fax:
*
Date Established:
*
Date Format: MM slash DD slash YYYY
City:
*
State:
*
Zip:
*
Country:
*
Website:
Does the Company own real property?
*
Yes
No
Do you do business in more than one place?
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Yes
No
If doing business in more than one place, please list additional addresses:
List all D/B/A, fictitious and assumed names:
Type of business:
*
Sole Proprietorship
Partnership
Corporation
Other
State in which incorporated:
*
States in which foreign-entity registered:
Organization number:
*
List your 5 largest customers:
*
Owner’s Name:
*
Social Security Number:
*
Home address:
*
City:
*
State:
*
Zip:
*
Owner
Rent
DOB
*
Date Format: MM slash DD slash YYYY
Ownership %:
*
Home Phone:
Fax:
Mobile:
*
Email address:
*
ADDITIONAL PRINCIPAL
Name:
Social Security Number:
Home address:
City:
State:
Zip:
Owner
Rent
DOB
Date Format: MM slash DD slash YYYY
Ownership %:
Home Phone:
Fax:
Mobile:
Email address:
ADDITIONAL PRINCIPAL
Name:
Social Security Number:
Home address:
City:
State:
Zip:
Owner
Rent
DOB
Date Format: MM slash DD slash YYYY
Ownership %:
Home Phone:
Fax:
Mobile:
Email address:
Do any of the Officers and/or Members have a Trust ?:
*
Yes
No
If yes, please provide the name(s) of the Trust(s) below and provide a copy of each Trust:
File
File
File
Accountant’s Name:
Firm:
Address:
City:
State:
Zip:
Phone:
Fax:
Mobile:
Email address:
Attorney’s Name:
Firm:
Address:
City:
State:
Zip:
Phone:
Fax:
Mobile:
Email address:
Federal Tax ID:
*
State Tax ID:
*
Local Tax ID:
*
Number of employees:
*
How often do you file 941 Payroll Taxes?
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Weekly
Monthly
Quarterly
Yearly
Are Payroll Taxes Current?
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Yes
No
Are there any outstanding Personal Property or Real Property taxes?
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Yes
No
If yes, how much?
Do you have any Federal or State Taxes past due?
*
Yes
No
If yes, has lien been filed?
Yes
No
If yes, list Type, Quarter, Year, and Amounts below:
Type:
Quarter:
Year:
Amount:
BUSINESS CHECKING ACCOUNT
Bank Name:
Address:
City:
State:
Zip:
Account Number(s):
Bank Officer’s Name:
Phone:
Fax:
BUSINESS LOAN ACCOUNT
Bank Name:
Address:
City:
State:
Zip:
Phone:
Fax:
How long with institution?
Loan Amount:
Collateral:
PERSONAL ACCOUNT
President
Proprietor
Partner
Bank Name:
Date account opened:
Checking Account Number:
Savings Account Number:
Address:
City:
State:
Zip:
Phone:
Fax:
What is the purpose of the funds to be generated from funding?
*
Is there a formal appraisal existing that provides the total liquidation value for the machinery and equipment of the operation?
*
Yes
No
If yes, please attach a copy of the appraisal.
If yes, what are the stated values contained in the appraisal?
If no formal appraisal exists, please provide an accurate machinery and equipment ledger:
Are receivables pledged as collateral?
*
Yes
No
If yes, to whom?
Is inventory pledged as collateral?
*
Yes
No
If yes, to whom?
Are there any commercial loans/leases outstanding?
*
Yes
No
If yes, list here:
Has the machinery and equipment been operated in any other physical location?
*
Yes
No
If yes, list all entities, names and Federal ID Numbers here:
How did you hear about Utica Leaseco?
Applicant's Electronic Signature:
*
Date
*
Date Format: MM slash DD slash YYYY
Printed Name:
*
Title
*
Email Address:
*
Phone Number:
*
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Phone: (248) 710-2134
info@uticaleaseco.com