Apply For Financing – Clean Aid, LLC

Commercial Application

Company Name *

Must be legal business name registered with the secretary of state. No nickname or abbreviated names. Please include LLC or INC if it is in your legal name.

Date *

Federal Tax # *

Have you ever declared bankruptcy? *

YesNo

Contact *

Address *

Must be a physical address

Street Address

Apt, Suite, Bldg. (optional)

City

State / Province / Region

Postal / Zip Code

Country

Phone Number *

Fax Number

Date Business Started *

Email *

Bank *

Number of Employees *

Bank Contact *

Bank Phone Number *

Account # *

Type of Business *

CorporationSole ProprietorLLCPartnership

Company's Annual Sales *

Your preferred equipment distributor *

Term in Months *

We submit at 72 months-btn unless otherwise stated.

Third Party Guarantee

Last Name *

First Name *

Middle Name *

SSN *

Birth Date *

Home Phone Number *

Driver's License # *

State *

Address *

Street Address

Apt, Suite, Bldg. (optional)

City

State / Province / Region

Postal / Zip Code

Country

Time at Address Yrs/Months *

Residential Status *

HomeownerRentOther

Rent / Mtg Payment *

Previous Address if less than 2 Years at Current Address

Time at previous address if less than 2 years at current address.

Email Address

Cell Phone Number

Employer Name *

Monthly Salary/Wages *

Work Phone Number *

Length of Employment in Years/Months *

Occupation *

Percentage Ownership in Company *

Previous Employer if less than 2 Years at Current Employment

Length of Employment Yrs/Months

Occupation

Other Income

Source

Disclaimer *

{X} By checking the above box , the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, authorizes lessor and/or debtor and their affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or credit worthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. By signing below, I/we affirm my/our identity as the respective individual(s) identified in this application and I/we authorize you to contact us at any numbers provided.

ECOA

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Lessor set forth above within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Verification

Please enter any two digits to verify you're not a robot *

Example: 12