Whitney Capital - Application

On-Line Application

HOME ABOUT WHY LEASE SERVICES APPLICATION CONTACT	Please print this form, and fax to: (203) 378-0390 CREDIT APPLICATION
	APPLICANT:
	CONTACT:
	STREET ADDRESS:

	CITY, STATE & ZIP CODE:	,
	TELEPHONE:
	FAX:
	TYPE OF BUSINESS:		YRS:
		CORP PART PROP
	EQUIPMENT:
		COST: $ TERM:
	VENDOR:
	CONTACT:
	STREET ADDRESS:

	CITY, STATE & ZIP CODE:	,
	TELEPHONE:
	FAX:
	PRINCIPALS
	Principal 1: NAME:
	STREET ADDRESS:

	CITY, STATE & ZIP CODE:	,
	TELEPHONE:
	SOCIAL SECURITY NO.:
	Principal 2: NAME:
	STREET ADDRESS:

	CITY, STATE & ZIP CODE:	,
	TELEPHONE:
	SOCIAL SECURITY NO.:
	BANK
	NAME:
	CONTACT:
	ACCOUNT NO.:
	TELEPHONE:
	TWO TRADE REFERENCES & LANDLORD
	Trade Reference 1: NAME:
	CONTACT:
	TELEPHONE:
	Trade Reference 2: NAME:
	CONTACT:
	TELEPHONE:
	Landlord: NAME:
	CONTACT:
	TELEPHONE:
	I verify the accuracy of the above information and authorize Whitney Capital, INC. to have bank and trade references release necessary information to verify the acceptability of my credit by typing my name and the date in the following fields:
	NAME: DATE:


	HOME ABOUT WHY LEASE SERVICES APPLICATION CONTACT Whitney Capital, Inc. 4 Daniels Farm Road Department 143, Trumbull, CT 06611 Tele:(203) 378-5036 Fax:(203) 378-0390 Email: whitneycap@aol.com