Broker Application - Global Financial & Leasing Services

Business

Broker (Exact Legal Name)

DBA

Contact Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Territory & Specialities

Deal Size Range

Typical Deal Size

Years in Business

Federal Tax ID

State of Incorporation

Member of the AACFB

Yes
No

Web Site Address

Email

Authorization

Please check box to confirm receiving (Opt-in) SMS text messages regarding account updates and requests for information. Text STOP to opt-out of receiving text messages.

Ownership

Principal #1 Name

Title

% Ownership

Principal #2 Name

Title

% Ownership

Funding Source References

Company #1

Contact Name

Phone

Company #2

Contact Name

Phone

Transaction Information

Please provide information on the type of business you do.

Equipment Types

Lessee Industries

Transaction Dollar Range

Questions

Have you as Broker and/or owner of Broker or any company affiliated with Broker ever filed for bankruptcy, been convicted of a felony or is the subject of a pending law suit?

Yes
No

If so, please explain

Forecasted Monthly Lease Applications:

Average Ticket Size

I/we represent that the above information is true and correct. This information is provided for the purpose of inducing Global Financial & Leas-ing Services, LLC to enter into and/or continue in a broker/lessor relationship with Broker subject to a Broker Agreement. I/we authorize you to investigate our business and personal banking, credit and business relationships for this purpose.

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Name

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