Eastern Marble & Granite


Online Application

  1. Lessee Company Information

Company Name

Company Address

City

State/Zip

Company Phone Number

Fax Number

E-mail

Years in Business

years

Federal Tax ID #

Annual Gross Income

Annual Sales

Net Worth

Business Classification

  2. Principals Information

Name (Principal #1)

Home Address

City

State/Zip

Home Phone Number

Social Security Number

Title/Position

% Ownership

%

Name (Principal #2)

Home Address

City

State/Zip

Home Phone Number

Social Security Number

Title/Position

% Ownership

%

  3. Company Banking Information (* required)

Bank Name

Routing Number

Account Number

Phone Number

  4. Proposed Equipment Acquisition

Equipment to be Financed

Estimated Cost

  5. Declaration/Authorization

By entering your name below, you accept and agree to the terms and conditions above.

Name (Princial #1 Electronic Signature)

Date

Name (Princial #2 Electronic Signature)

Date

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