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Third Party Originator ApplicationTPO INFORMATIONCompany Name: FORMTEXT ????? DBA Name: FORMTEXT ?????Address w/ City, State, Zip FORMTEXT ?????Phone # FORMTEXT ?????Fax # FORMTEXT ?????Main Contact Email FORMTEXT ?????Year Business Started: FORMTEXT ?????Website Address: FORMTEXT ?????Type of Business: FORMCHECKBOX Corporation FORMCHECKBOX LLC FORMCHECKBOX Proprietorship FORMCHECKBOX PartnershipMembership(s) FORMCHECKBOX NEFA FORMCHECKBOX ELFA FORMCHECKBOX NAELB FORMCHECKBOX OtherCredit Reports Used: FORMCHECKBOX Equifax FORMCHECKBOX Trans Union FORMCHECKBOX Experian FORMCHECKBOX OtherPRINCIPALSName FORMTEXT ?????Email FORMTEXT ?????Title FORMTEXT ?????% Ownership FORMTEXT ?????Address w/ City, State, Zip FORMTEXT ?????Phone FORMTEXT ?????S.S. # FORMTEXT ?????Name FORMTEXT ?????Email FORMTEXT ?????Title FORMTEXT ?????% Ownership FORMTEXT ?????Address w/ City, State, Zip FORMTEXT ?????Phone FORMTEXT ?????S.S. # FORMTEXT ?????CURRENT FUNDING SOURCESCompany Name FORMTEXT ?????Contact FORMTEXT ?????Email Address FORMTEXT ?????How Long With? FORMTEXT ?????Annual Funding FORMTEXT ?????Company Name FORMTEXT ?????Contact FORMTEXT ?????Email Address FORMTEXT ?????How Long With? FORMTEXT ?????Annual Funding FORMTEXT ?????Company Name FORMTEXT ?????Contact FORMTEXT ?????Email Address FORMTEXT ?????How Long With? FORMTEXT ?????Annual Funding FORMTEXT ?????Company Name FORMTEXT ?????Contact FORMTEXT ?????Email Address FORMTEXT ?????How Long With? FORMTEXT ?????Annual Funding FORMTEXT ?????ADDITIONAL INFORMATIONTotal # of Employees: FORMTEXT ?????# of Sales People: FORMTEXT ?????Annual Lease Funding: $ FORMTEXT ?????Origination of New Leases FORMTEXT ?????% Vendor FORMTEXT ?????% Broker FORMTEXT ?????% End UserYears in Equipment Leasing Industry: FORMTEXT ?????Specific Industries You Specialize In: FORMTEXT ?????What are the CORE PRODUCTS You Offer?: FORMTEXT ?????Average Transaction Size: FORMTEXT ?????Estimated Monthly Volumes to FinPac: FORMTEXT ?????APPLICANT’S STATEMENT AND AUTHORIZATION TO RELEASE BANK INFORMATIONApplicant has answered the questions in this application fully and truthfully. Applicant understands that Financial Pacific Leasing, Inc. or its assigns ("Lessor") may check Applicant's credit and bank records, in addition to any statements Applicant has made. Applicant specifically grants all of its creditor’s permission to release to Lessor any information Lessor requests in order to determine whether Lessor wants to grant Applicant credit. Applicant gives Lessor permission to give credit reporting agencies and other creditors information relating to any credit Lessor might grant Applicant.A ELECTRONIC VERSION OF THIS DOCUMENT SHALL BE CONSIDERED AN ORIGINALSignature:__________________________________________________ Date: ___________________ ................
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