NEC Financial Services, LLC - Credit Application

Credit Application

*Fields marked in red asterisks are required.

*Complete Legal Customer Name:
Are you a current NEC Lease customer?:	Yes No
If yes, Account #:

Customer Headquarters Address

*Address:
*City:	State: Zip:
*Phone:	Fax:
Web Site Address:
*Contact Name:
*Contact E-Mail Address:

Dealer/Vendor Information

*Dealer/Vendor Name:
Address:
City:	State: Zip:
Phone:	Fax:
*Sales Rep/Contact Name:

Equipment/Software

*Equipment/Software Description:
Equipment Cost:
Software Cost:	Not applicable for FMV, blended rates may be required.
Tax (if applicable):
*Total Cost:
*Term Requested:	12 24 36 48 60 Other:
*Lease Type:	FMV 10% $1 Out Other:
Mo. Lease Payment:	Lease Rate Factor:
Advance Rentals:

Equipment/Software Address
Check here if same as headquarters.

Street Address 1:
Street Address 2:
City:	State: Zip:
Business Telephone:
Business Fax:

Billing Address
Check here if same as headquarters.

Street Address 1:
Street Address 2:
City:	State: Zip:
Billing Contact:

Background

*Nature of Business:
*Sole Owner Partnership Corporation Other:
State of Incorporation:
*Year of Inception:
Federal Tax I.D. #:
Landlord Name:
Street Address 1:
Street Address 2:
City:	State: Zip:
Telephone:

Major Stockholders/Owners/Partners
(If company is in business for less than three years, this information might be required.)

Stockholder/Owner 1
Principal Owner Partner Officer
Name:
Title:
Social Security Number:
Home Address:
City:	State: Zip:
Home Telephone:

Stockholder/Owner 2
Principal Owner Partner Officer
Name:
Title:
Social Security Number:
Home Address:
City:	State: Zip:
Home Telephone:

Bank References

Bank
Business Bank/Branch:
Checking Account Number:
Bank Contact:
Bank Phone:
Bank Fax:
Loans at this bank:	Yes No

Bank/Lease/Finance
Business Bank/Lease Company:
Account Number:
Bank Contact:
Bank Phone:
Bank Fax:
Loans at this bank:	Yes No

Trade References

Trade 1
Major Supplier:
Street Address:
City:	State: Zip:
Contact:
Phone:

Trade 2
Supplier:
Street Address:
City:	State: Zip:
Contact:
Phone:

Additional info and special requests:

Notice:
To NEC Financial Services, LLC: I/We grant NEC Financial Services, LLC or its Agent's permission to investigate my/our financial responsibility and credit worthiness, and authorize release of any personal or business information accordingly. I/We agree to make available financial statements, tax returns, etc., upon request. I/We acknowledge that any Advance Rental(s) and/or Security Deposit(s) are not refundable if NEC Financial approves our application for credit. I/We certify that this application for credit is for a commercial purpose and not for personal, family or household purposes.

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