Westover Financial, Inc. Westover Financial Credit Application

Required fields are marked with an asterisk*

General Information
Company Name: 1. *
Telephone: 2. *
E-mail: 3. *
Fax: 4.  
Street Address: 5. *
City: 6. *
State: 7. *
Zip Code: 8. *
Federal Tax ID Number: 9.  
Years in Business: 10. *
Trade Name or DBA: 11.  
Type of Business: 12. *
(Please specify and check 12a. Corporation  
one of the selections) 12b. Partnership  
  12c. Sole Proprietorship  
  12d. Other  
       
Owners/Principal Information
Principal 1: 13. *
Title: 14. *
Social Security Number: 15. *
Street Address: 16. *
City: 17. *
Zip Code: 18. *
Telephone: 19. *
       
Principal 2: 20.  
Title: 21.  
Social Security Number: 22.  
Street Address: 23.  
City: 24.  
Zip Code: 25.  
Telephone: 26.  
       
Banking Information
Bank 1: 27. *
Account Number: 28. *
Account Type: 29. *
Contact: 30. *
Telephone: 31. *
       
Bank 2: 32.  
Account Number: 33.  
Account Type: 34.  
Contact: 35.  
Telephone: 36.  
       
Credit References
1st Reference: 37. *
Account Number: 38. *
Contact: 39. *
Telephone: 40. *
       
2nd Reference: 41. *
Account Number: 42. *
Contact: 43. *
Telephone: 44. *
       
3rd Reference: 45.  
Account Number: 46.  
Contact: 47.  
Telephone: 48.  
       
Landlord: 49.  
Contact: 50.  
Telephone: 51.  
       
Equipment and Vendor Information
Vendor: 52.  
Telephone: 53.  
Fax: 54.  
Address: 55.  
City: 56.  
State: 57.  
Zip Code: 58.  
Equipment Description: 59.  
Equipment Cost: 60. *
Term: 61. *