(1) BUSINESS INFORMATION
This business is a: Corporation Sub "S" Corporation Partnership Proprietorship Limited Liability Partnership
  Non-Profit Organization Other (Specify):
Full Name of Business (include any DBA's)
Years in Business
Federal Tax ID No.
Business Street Address Including City, State & Zip
Area Code & Telephone No.
Fax Number
Nature of Business
Primary Contact
Principal's Full Name(s)
Title
Home Address
Social Security No.
Landlord Information for Equipment Location
Primary Contact
Area Code & Telephone No.
Address Where the Equipment will be Located if Different from Main Business Address
(2) BANK INFORMATION (AT LEAST 2 YEARS HISTORY)
Name of Bank Contact Name Account No. Date Opened Area Code & Telephone No. Fax Number
(3) TRADE REFERENCE INFORMATION (FOUR GOOD REFERENCES - ONE OR MORE SHOULD BE COMPARABLE IN SIZE TO THIS REQUEST)
Trade Reference Contact Name Account No. Date Opened Area Code & Telephone No. Fax Number
Gilmore Bank requires both a Financial Statement (which can be submitted online) and your company's previous year's Tax Return in order to approve your Leasing Application. Please check the following:
Financial Statements will be: Submitted Online  Mailed  Faxed  Delivered to Bank    by (date)
Tax Returns will be: Mailed  Faxed  Delivered to Bank    by (date)
(4) EQUIPMENT DESCRIPTION INFORMATION
Give a full and complete description of equipment. Please send actual quotations and copies of brochures when possible.
(5) VENDOR INFORMATION
Name:
Telephone:
Fax:
Contact:
Address:
City, State, Zip:
Equipment Cost Before Tax Sales Tax % Lease Term Desired Has any Factor or Payment been Quoted?
BANK AND TRADE RELEASE
The undersigned on behalf of the business, and each individual listed in section 1 hereof authorize Gilmore Bank to receive from, and give to, the undersigned on behalf of the business' or individual's accounts or credit experience; and the undersigned authorizes any party listed hereon, to release to Gilmore Bank, information about the business' or individual's accounts or credit experience. This shall be authorization for all present and future disclosures of account information and credit experience on the business and individuals listed hereon made by Gilmore Bank, or any party requested to release such information to Gilmore Bank.
THIS IS YOUR WRITTEN AUTHORIZATION TO RELEASE THE REQUESTED INFORMATION.
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By

Name

Company Name

Title

Date
 
   
 
Member FDIC. Equal Housing Lender.