COVER LETTER
* Tell us everything you know about the note/deal:

BROKER INFORMATION
First Name:
Last Name:
Date:
Company:
Title:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

CONTACT INFORMATION
* First Name:
* Last Name:
* Lessee Full Company Name:
* Email:
* Legal Name of Entity:
Title:
* Address:
* City:
* State:
* Zip:
* Phone:
Fax:

BUSINESS INFORMATION
* DBA:
* Type of Business:	Corporation Partnership  Proprietors
* Years in Business: (under present control)
* First Bank Name:
* Phone:
* Contact Name :
* Account Number:
Second Bank Name:
Phone:
Contact Name :
Account Number:

TRADE REFERENCE
* Company Name:
* Phone:
* Contact Name:
Account Number:

FINANCE REFERENCE
* Company Name:
* Phone:
* Contact Name:
Account Number:

LANDLORD
* Company Name:
* Phone:
* Contact Name:
Account Number:

 

PRINCIPALS
* First Principal Name:
* Home Address:
* City:
* State:
* Zip Code:
* Home Phone:
* Social Security Number:
* Ownership %:
Second Principal Name:
Home Address:
City:
State:
Zip Code:
Home Phone:
Social Security Number:
Ownership %:
Third Principal Name:
Home Address:
City:
State:
Zip Code:
Home Phone:
Social Security Number:
Ownership %:

EQUIPMENT INFORMATION
* Equipment Location: (if different from above)
* Dealer Name:
* Contact Name:
* Phone:
* Dealer Address:
Fax:
* Terms:
* Estimated Monthly Payment:
* Estimated Delivery Date:
* Equipment Description:

    

* Required Field

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