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| M & M Funding Solutions |
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| "Cash in your hand, not in the mail" |
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APPLICATION
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| *Name of Company | |
| *Address | |
| *City | |
| *State | |
| *Zip Code | |
| *Phone | |
| *Fax | |
| *Email | |
| *Contact Person | |
| *Contact Person Title | |
| *Type of Business | |
| *Type of Entity Corp.,LLC.,Partnership,etc... | |
| *Federal Tax ID # | |
| *Year Business Established | |
| *How Long Under Current Ownership? | |
| *Will Equip. Be Located at Address Above? | |
| If not, Where Will it be Located? | |
| *Owner/Officer's Name | |
| *Ownership % | |
| *Title | |
| Social Security No. | |
| Home Address | |
| .City | |
| .State | |
| .Zip | |
| Owners/Officer's Name | |
| -Ownership % | |
| -Title | |
| -Social Security No. | |
| -Home Address | |
| -City | |
| -State | |
| -Zip | |
| *Trade References List 4 With Name,Phone&Contact | |
| *Name of Bank | |
| *Checking Account No. | |
| Date Opened | |
| Previous Bank | |
| Previous Bank Checking Account No. | |
| Number of Years With That Bank? | |
| Leasing Company Reference | |
| Contact Name & Number | |
| *Describe Equipment to be Leased | |
| *New or Used | |
| *Total Cost of Equipment | |
| *Equipment Supplier | |
| *,Address | |
| *,City | |
| *,State | |
| *,Zip | |
| *,Contact Person | |
| *,Phone | |
| *,Fax | |
| Comments | |
| | * Denotes a required field |
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| Copyright © 2008 M & M Funding Solutions. |
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