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CREDIT APPLICATION

"*" indicates required fields

APPLICANT:

Company Legal Name:*

Proprietorship, Partnership, Corporation, Other:*

Address:*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone:*

Cell Phone #:*

Email:*

Type of Business:*

Time in Business:*

PRINCIPALS:

Name:*

Title:*

SS #:*

Home Address:*

EQUIPMENT DESCRIPTION:*

New or Used:*

Equipment Cost: $*

Quantity:

Vendor:*

Contact:*

Address:

Phone #:

BANK REFERENCE:*

Contact:

Type of Account:

Acct #:

TRADE REFERENCE:

City & State:

The undersigned authorizes the release of any credit information to: TECK Financing, Inc. or the assigned on loans, leases, checking, savings, trades, and personal credit bureau, now and in the future.

Signature:

Date:

Name

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For Quick Phone Applications Call 1-800-565-3884 – Cheri Ext 252 or Evan Ext 253 Or Email the Completed Application to cheris@teckfinancing.com or evans@teckfinancing.com To Complete by Fax Send to: TECK Financing, Inc. – Attention -Cheri at: 308-381-8642