STERLING NATIONAL BANK
FAX: 888-232-6823
PHONE: 212-575-2474
ONLINE CUSTOMER APPLICATION
CUSTOMER INFORMATION
Customer (Full Legal Name)
Tel No.
Fax No.
Email
Trade Style/DBA
Nature of Business
Headquarters Address
City
State
Zip Code
Address for this Equipment
City
State
Zip Code
How long in business?
Estimated Installation Date
Contact
Check ONE:
Corporation
Date of Inc.
State of Inc.
Not for Profit
Date of Inc.
State of Inc.
Proprietorship
Limited Partnership
Genertal Partnership
State or Local Govt
Limited Liability Co
Limited Liabilty Partnership
Parent Company
Name:
Address:
City, State, Zip:
OFFICER/PRINCIPAL/OWNER
Officer/Principal/Owner
Title
SS#
Complete Home Address
City, State, Zip
Officer/Principal/Owner
Title
SS#
Complete Home Address
City, State, Zip
BANK INFORMATION
Bank Name
Contact Name
Phone No.
Fax No.
Account Type
Account Number
Year Opened
Bank Name
Contact Name
Phone No.
Fax No.
Account Type
Account Number
Year Opened
TRADE REFERENCES
Company
Contact Name
Phone No.
Fax No.
No. Year
Company
Contact Name
Phone No.
Fax No.
No. Year
EQUIPMENT (Check One)
New
Used
Describe Equipment:
LEASE STRUCTURE
Lease Type:
$1 Purchase Option
%Purchase Option
%
FMV Purchase Option
Lease Term (Check One):
24
36
48
60
Other
Lease Rate Factor:
Rental Amount $
No. of Advance Rentals:
2
Other
Equipment Dealer
Equipment/Installation/Shipping Costs $
PHONE
Other $
FAX
Sales Tax $
SALE REP. NAME
TOTAL $
By signing below, the undersigned, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Sterling National Bank or its designees (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purpose of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signing below I/we affirm my/our identity as the respective individuals/s identified in the above application. We hereby authorize the release of information requested by Sterling Bank Leasing regarding our bank and trade relationships.
By:
Title:
Date:
Guarantor: