ALLMEDIA
LOAN/LEASE APPLICATION
CAPITAL
(all transactions)
Company Name:
_________________________________________ Federal Tax ID ________________________
Full Address:
_______________________________________________________________________________ (Street Address)
(City)
Telephone Number:
(County)
(State)
(ZIP)
Fax Number:
Name and Title of Person to Contact:
_______________________________________________________________
Nature of Business: _________________________________________ Date Established: ______________________ Is your Business:
[ ] “C” Corporation [ ] Subchapter “S” Corporation [ ] Partnership [ ] Sole Proprietorship Formed Under the Laws of the State of __________________
Number of Employees: ______
Facility Description: _________________________________________________
Major Customers & Percentage of Sales:___________________(
%)
____________________( %) _____________________( %)
Ownership: Name / Percentage owned: Title of Office: #: Home Address: #: City, State, Zip: Home Phone #: Social Security #:
Stockholder Stockholder Stockholder __________________( %) ____________________( %) ____________________( %) __________________ ____________________ ____________________ __________________ ____________________ ____________________ __________________ ____________________ ____________________ __________________ ____________________ ____________________ __________________ ____________________ ____________________
References: Banking Information: Name of Bank: Contact Name: Checking Acct. No.: Savings Acct. No.:
______________________________ ______________________________ ______________________________ ______________________________
City/State: _____________________ Telephone #: _____________________
Trades: Name of Trade Contact Name:
______________________________ ______________________________
City/State: _____________________ Telephone #: _____________________
Name of Trade Contact Name:
______________________________ ______________________________
City/State: _____________________ Telephone #: _____________________
Name of Trade Contact Name:
______________________________ ______________________________
City/State: _____________________ Telephone #: _____________________
Name of Trade Contact Name:
______________________________ ______________________________
City/State: _____________________ Telephone #: _____________________
Other Accts.: _____________________
Any Previous Business with All Media Capital: [ ] No [ ] Yes: When: _________________________ Page 1 of 2
711 E. Imperial Hwy., Suite 202
Brea, California 92821
Phone: (714) 671-4100
Fax: (714) 671-6922
ALLMEDIA Other Sources of Financing:
Name
Phone #
___________________ ___________________ ___________________ ___________________
_______________ _______________ _______________ _______________
Account Numbers _____________________ _____________________ _____________________ _____________________
CAPITAL Monthly Payment _________________ _________________ _________________ _________________
Description of Proposed Equipment: ( ___ New / ___ Used: Year _______) ____________________________________________________________________ Price: Down Payment: Trade-in Allow.: Installation: Total Requested:
_______________________ _______________________ _______________________ _______________________ _______________________
Expected Delivery Date:
Total Term of Financing Requested: _____ Years Special Vendor Terms: ____________________
______________________
Address Equipment will be Located: _________________________________________________________________ (Street Address) (City) (County) (State) ZIP) Name of Landlord or Mortgage Holder:
____________________________________________________________________________
Premises Owned ___ or Rented ___
Contact Name: ___________________ Telephone #: _______________
Insurance Carrier: Contact Name:
______________________________ ______________________________
Telephone #: _____________________
Accountant: Contact Name:
______________________________ ______________________________
Telephone #: _____________________
Please Explain How _____________________________________________________________________________ This Equipment will _____________________________________________________________________________ Help Your Operation: ____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Please Submit
Last Three (3) Year End Financial Statements Last Three (3) Year End Federal Tax Returns Current Year-to-Date Statement with Comparative to Last Year Same Period Results Last Two (2) filed Federal Tax Returns (1040) of Officers Personal Financial Statements of Officers Page 2 of 2
711 E. Imperial Hwy, Suite 202
Brea, California 92821
Phone: (714) 671-4100
Fax: (714) 671-6922
ALLMEDIA
711 E. Imperial Highway Suite 202 Brea, CA 92821 Tel: 714.671.4100 Fax: 714.671.6922
CAPITAL
TO ALL CREDITORS OF:
DATE:
CUSTOMER NAME: CUSTOMER ADDRESS: City
State
Zip
Dear Creditor: All Media Capital, has been requested to review the above referenced company/individual for possible financing. Please provide the information requested on the pages attached hereto and return via fax to the number and representative that has made the request. Please respond within 24 hours of the request. If you are unable to respond within 24 hours, please contact the representative who has made the request to inform them of the delay. Thank you for your prompt attention to this matter. I/We hereby certify that all information contained in this application, and all attachments hereto, are true and complete to the best of my knowledge, and are made for the purpose of obtaining credit. The undersigned individual, who is either a principal of the applicant or personal guarantor of its obligations, provides written instruction to All Media Capital and/or its assignee/designee authorizing review of his/her personal credit profile from a National credit bureau. Such authorization shall extend to obtaining a credit profile in consideration of this application and subsequently for the purposes of update, renewal or extension of such credit and for reviewing or collecting the resulting account. I/We authorize the verification of any of the information from whatever source it deems appropriate and I/we further authorize any credit reference provided by us to All Media Capital and/or its assignee/designee to release credit information. I/We agree to notify you of any material change in the condition of my affairs, and this statement shall be construed by you to be a continuing statement of the conditions of the undersigned until written notice to the contrary is received by you. The applicant also agrees and understands that the information provided by the applicant may be shared with other entities such as financial institutions, rating agencies, funding sources and accountants. It is understood that this application shall remain the property of All Media Capital, whether or not credit is granted to us, and that this constitutes an application only and is not binding upon either All Media Capital or the applicant. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth (for individuals), and other information that will allow us to identify you. We may also ask to see your driver’s license (for individuals) or other identifying documents. BY MY SIGNATURE BELOW, MY AUTHORIZATION IS HEREBY GIVEN FOR YOU TO RELEASE INFORMATION REQUESTED BY ALL MEDIA CAPITAL AND OR ITS DESIGNEE/ASSIGNEE AS DIRECTEDABOVE: SIGNATURE
SIGNATURE
PRINT NAME
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SSN
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