330 172nd
Ave. N.E. Redmond, WA 98008 Phone: 206-768-9828
Fax: 425-861-9743
Applicant Information:
Company Name: _________________________________________________________
Company Contact: _______________________________________________________
Billing Address: _________________________________________________________
City: _____________________________ State:______ Zip:______________________
Phone Number:_________________________ Fax Number: _____________________
Contact E-mail Address:___________________________________________________
Company URL Address: http://______________________________________________
Company start date:____________________
Type of business: Sole Ownership ( ), Partnership ( ), Corporation ( ).
Name of Principle: ________________________________________________________
Social Security Number: ___________________________________________________
Address: ________________________________________________________________
City: _____________________________ State:______ Zip:______________________
Phone Number:_________________________
Name of Additional Principle: ________________________________________________________
Social Security Number: ___________________________________________________
Address: ________________________________________________________________
City: _____________________________ State:______ Zip:______________________
Phone Number:_________________________
Describe the nature of your Business:_________________________________________
Is your Business Registered in the state of Washington? Yes ( ), No ( )
Washington State UBI Number: _____________________________________________
Federal ID Number:_______________________________________________________
Bank:___________________________________________________________________
Bank Officer: ____________________________________________________________
Bank account number: _____________________________________________________
Bank Address: ___________________________________________________________
City: _____________________________ State:______ Zip:______________________
Phone Number:_________________________
1st Trade Reference: ______________________________________________________
Contact Name: __________________________________________________________
Account Number: ________________________________________________________
Phone: _____________________________ Fax Number: ________________________
2nd Trade Reference: ______________________________________________________
Contact Name: __________________________________________________________
Account Number: ________________________________________________________
Phone: _____________________________ Fax Number: ________________________
3rd Trade Reference: ______________________________________________________
Contact Name: __________________________________________________________
Account Number: ________________________________________________________
Phone: _____________________________ Fax Number: ________________________
We certify that the above information is correct and authorize the above named banks and/or trade references to disclose any information on credit worthiness. We fully understand your rental contract and agree to the proper payment in consideration of extended credit.
Signature of Owner or Officer: ______________________________________________
Title: ___________________________________________________________________
Date: __________________________________________________________________