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

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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