MONTGOMERY EQUIPMENT LEASING COMPANY

P.O. Box 97, Cheltenham, PA 19012

Telephone:  215-663-2350    Fax: 215-663-2352

CONFIDENTIAL CREDIT APPLICATION

FULL LEGAL NAME:                                                                                                                                                                        

ADDRESS:                                                                    CITY:                                        STATE:            ZIP: ______________

TELEPHONE:                                                                FAX:                                                                          

NATURE OF BUSINESS:                                                          Length of time in business :                                                      

TYPE OF BUSINESS: Corporation / Partnership / Proprietorship (Circle one)

FED. ID #_______________________________________________________________________

NAME OF PRESENT BANK:                                                                                                                                     

Telephone: ____________________________________ Bank officer: _________________________________

Account Number:                                              Length of time at bank:                                     

NAME OF PREVIOUS BANK: _____________________________________________________

Telephone: ________________________Account Number:________________________________

THREE TRADE REFERENCES:

NAME:                                                             Contact:_________________________________

Address: _________________________________ Telephone:                                                                                

NAME:                                                             Contact: ________________________________________________

Address: _________________________________ Telephone:                                                                                  

NAME:                                                              Contact: ________________________________________________

Address: ___________________________________Telephone:                                                        

OWNERSHIP INFORMATION: Please list the full legal names of the owners of the business.  If a publicly traded firm, list officer who will be responsible for signing the lease.

NAME:                                                  Title:                     % Ownership:                            

SS#:                                                           

Home Address:                                                             City:                              State:           Zip:                 

Date of Birth:                       

Home Phone #:                                            Spouse's Name:                                               

SS#:                                              

NAME:                                     Title:                       % Ownership:                          

SS#:                                              

Home Address:                                                             City:                              State:           Zip:                 

Date of Birth:                       

Home Phone #:                                                 Spouse's Name:                                                            

SS#:                                              

I/We, either a principal of the credit applicant listed above or a personal guarantor of its obligations, provide written authorization to Montgomery Equipment Leasing Co. or its assigns to investigate my/our personal credit history from a national credit bureau, which shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purposes of update renewal or extension and for reviewing or collecting the resulting account.  A photocopy or facsimile copy of this shall be as valid as the original.  I/We also authorize My/Our financial institutions and creditors to release information required.

AUTHORIZED SIGNATURE: X                                                          DATE:                                                            

AUTHORIZED SIGNATURE: X                                                          DATE:                                                           



Please FAX completed form to 215-663-2352