Live Bait Vendor Lease Application

One Stop Bait Shop TM Live Bait Vendor Steve's Bait PO Box 12 Galion Ohio 44833 PH. (419) 566-9207 Fax. (419) 468-3102 E-mail: kgwrld@hotmail.com

* Note: if your concerned about submitting sensitive information online Please click here for alternative application process. Thank You.

Lease Application Legal Business Name:
Address:
City:    State:    Zip Code:
Phone #:    Extension:    Fax #:
Contact Person:

Equipment Description: Live Bait Vending Machine Price: $3595 Each

Quantity Desired:

Years in Business: Type of Business:
Federal Tax ID Number: Corporation Partnership Proprietorship

Personal Information of Officers Partners or Grantors

Name:
Title:    Social Security Number:
Home Address:
City:    State:    Zip Code:
Home Phone #:

Company Bank References - Two Year History
(please provide prior bank reference if current bank relationship is less than 2 years)

Name of Bank Branch:
City:    State:     Zip Code:
Phone #:    Fax #:
Checking Account #:
Loan Account #:

Name of Bank Branch:
City:     State:     Zip Code:
Phone #:    Fax #:
Checking Account #:
Loan Account #:

Trade References - Two Year History

Name of Supplier:
Account #:
Phone #:    Fax #:
Contact Person:

Bank and Trade Release I hereby authorize our bank and trade references to release the information requested by Center Financial Leasing Inc. regarding our company's accounts with your firm. Please respond to their telephone request or by fax, if you need written proof of the request and our release. This is Your Written Authorization to Release the Information Requested. Authorized By:
Title: Date: (MM/DD/YYYY)

Click Here to print this application to mail or fax

This site designed by Barbara Gottfried