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Associated Corporate and Institutional Services, Co.

Turn-key Design, Construction, Furniture, Flooring and More

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Fax 1-866-9-ACISCO
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Business Applicant

Note: Mandatory fields are marked with "*".

COMPANY LEGAL NAME (Include DBA if applicable) *
CONTACT NAME *
PHONE NO. *
ADDRESS *
CITY *
STATE *
COUNTY *
ZIP CODE *
FAX NO. *
TYPE OF BUSINESS *
DATE EST. *
YRS. CURRENT
OWNERSHIP *

# OF EMPLOYEES
FED. TAX ID# *
STRUCTURE OF
OWNERSHIP

Proprietor
Partnership
Corp

Ownership

Note: Please type your full legal name in ALL CAPS in the signature boxes below to sign this form.

Principal Officer

PRINCIPAL'S NAME *
TITLE *
% OF OWNERSHIP
SIGNATURE APPROVAL OF
CREDIT REVIEW (SEE BELOW) *

DATE SIGNED *
HOME ADDRESS *
SOC. SEC. # *
HOW LONG *
OWN OR RENT?
Own *
Rent
HOME PHONE *

Second Principal Officer

PRINCIPAL'S NAME
TITLE
% OF OWNERSHIP
SIGNATURE APPROVAL OF
CREDIT REVIEW (SEE BELOW)

DATE SIGNED
HOME ADDRESS
SOC. SEC. #
HOW LONG
OWN OR RENT?
Own
Rent
HOME PHONE

Banks/Lenders

First Account

BANK/LENDER NAME *
BRANCH *
PHONE NO. *
Checking Acct. *
Savings Acct.
Lease
Loan
NAME ON ACCOUNT *
ACCOUNT # *
DATE OPENED *
AVG. BALANCE *

Second Account

BANK/LENDER NAME
BRANCH
PHONE NO.
Checking Acct.
Savings Acct.
Lease
Loan
NAME ON ACCOUNT
ACCOUNT #
DATE OPENED
AVG. BALANCE

Trades

COMPANY NAME *
PHONE *
ADDRESS *
CONTACT
COMPANY NAME *
PHONE *
ADDRESS *
CONTACT

Equipment Requested

VENDOR
PERSON TO CONTACT
PHONE NO.
EQUIPMENT DESCRIPTION
COST

IMPORTANT - READ BEFORE SIGNING

By my/our signature on this Application, either as a principal of the applicant or a personal guarantor of applicant's obligations, I/we hereby certify that all information contained in this Application and all attachments hereto, are true and complete to the best of my/our knowledge, and are made for the purpose of obtaining credit. I/we authorize CNLC, or its designee (and any assignee or potential assignee thereof), to verify any of the information from whatever source it deems appropriate, which authorization shall extend to obtaining and review of my/our personal credit profile from a national credit bureau in considering this Application and subsequently for the purpose of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. If this Application for business credit is denied, you have the right to a written statement of the specific reasons for denial. To obtain the statement, contact CNLC within 60 days from the date you are notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The Federal Equal Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into a binding contract); or because all or a part of the applicant's income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580. A Copy or Facsimile of this Agreement with Signature shall be Considered to be an Original.

Enter your email address if you'd like to be emailed a copy of the completed application:

 

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