800.338.5872
951.736.1377 24 - Hour Fax Line
_______________________________________________________________________________
Corporate or Business Name: ________________________________________________________
DBA Name: ______________________________________________________________________
Address: ________________________________________________________________________
City: ___________________________________State: _____ Zip: __________________________
Buisness Phone: __________________Home Phone ________________Fax___________________
Equipment Location: Same ________________________ Other ____________________________
Type of Business: ___________________________________________ Years in Business: _______
Principals: President, Owners, Partners
Name: ______________________________________________ SS#: _______________________
Home Address: ___________________________City____________________Zip_______________
Date of Birth: ______________ Drivers License: _______________________ State Issued: _______
FED TAX ID# _________________ Prop_________ Partnership _______ Corporation ____ LLC ____
Lessee’s Bank & Branch:_____________________________________________________________
City & State: _________________________________________ Acct #:______________________
Years @ Bank: ________ Contact:_________________________ Phone #:____________________
TRADE REFERENCES (Businesses where you have lines of credit, leases or Finance)
Name Phone# Contact Person
1)_____________________________________________________________________________________
2)_____________________________________________________________________________________
3)_____________________________________________________________________________________
Term 36 48 60 (Circle One) Anticipated Down Payment_____________________________________
By signing below, the undersigned individual as principal of and/or guarantor for the applicant,
authorizes Tiffany or its assign, (Broker or Lessor), its designee, assigns or potential assigns, to
review his/her personal credit profile provided by national credit bureaus in considering this
application and for the purpose of the update, renewal, or extension of credit to the applicant
or the collection of any resultant accounts. A faxor photocopy of this authorization shall be valid
as the original.
Signature: ______________________________ Date: _____________________
Signature: ______________________________ Date: _____________________
