Financing

FINANCING

Please fill out and print the form below, then fax to 323-869-1001. Thank you!

Company Name:
Description of Business:
Type of Business:
Business Start Date:
Federal Tax ID:
Number of Employees:
(Principal One) First Name:
Title:
Social Security Number:
(Principal Two) Last Name:
Bank Name:
Bank Phone Number:
Bank Account Number:
Average Balance:
Please select the amount of financing :
Contact Information:
Minimum Order Quantity:	1
Please describe how your company will use the financing:

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