Greystone Financial Group, Inc.

Credit Application

Business Name:
Contact Name:
Business Phone:	. .
Cell:	. .
Email:
Address:
City:
State:
Zip:
County:
Business Structure:
Date of Birth:
Nature of Business:
How Long Established:	Month: Year:
Years Under Current Ownership:
Years of Industry Experience:
Federal Tax ID #:
LOCATION OF EQUIPMENT:
Address:
City:
State:
Zip:
County:
Ownership Information
Owner's Legal Name:
Generation:
Title:
% Ownership:
Home Phone:	. .
Social Security #:	- -
Address:
City:
State:
Zip:
County:
Owner's Legal Name:
Title:
% Ownership:
Home Phone:	. .
Social Security #:	- -
Address:
City:
State:
Zip:
Filed for Bankruptcy?:
Date Discharged:
Bank References (2 Year History)
Business Bank:
Business Checking #
Date Account Opened:
Address:
Contact Officer:
Phone:	. .
Personal Bank:
Checking Acct #
Phone:	. .
Trade / Supplier References
Trade / Supplier reference:
Contact / Acct #
Phone:	. .
Trade / Supplier reference:
Contact / Acct #
Phone:	. .
Business Insurance Agent:
Business Insurance Agent:
Contact:
Phone:	. .
Fax:	. .
Equipment Information
Equipment Cost (excluding sales tax):
Equipment Description: (Manufacturer, Model #, Serial#)
Lease Plan (10% or $1):
Number of Months:
New or Used:
Year:
Dealer / Vendor Information
Supplier of Equipment:
Address:
City:
State:
Zip:
Phone:	. .
Contact:
CREDIT RELEASE AUTHORIZATION: The undersigned individual who is either a principal, a personal guarantor or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents and authorizes Greystone Financial Group, Inc. or its designee the use of a consumer credit report on the undersigned, from time to time as may be needed.