printa-system-logo.jpgCredit Application


Please fill out this form as completely as possible.

Company Information

Applying For:*
Lease
Working Capital
Both
Amount of Working Capital in US Dollars
Business Type:*
Partnership
Sole Prop
LLC
Corporation
Company Name*
Phone*
Email*
Street Address*
City*
County*
State*
Zip Code*
Years in Business*
Annual Sales Last Calendar Year
Date of Inc.
Nature of Business*
Fed Tax ID (If Applicable)
Company Website

Principal Information (On Officers, Partners or Guarantors)

Name*
Title*
SSN*
Date of Birth*
Home Street Address*
City*
State*
Zip Code*
Home Phone*
Ownership*
Name
Title
SSN
Date of Birth
Home Street Address
City
State
Zip Code
Home Phone
Ownership

Vendor Information (Business Systems Provider)

Company Name

Printa Systems, LLC

Address

1359 Commerce Way
Idaho Falls, ID 83401

Telephone Number

855-777-7013

Fax Number

208-567-0205

Sales Contact*
Printa Systems Business Program*
Amount*
Budgeted Monthly Payments*

By entering my name below, I am signing this application. The undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to the Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile for a national credit bureau, as well as obtaining bank and/or other credit information as required. Such authorization shall extend to obtaining a credit profile in considering this application subsequently for the purposes of update, or renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat or facsimile of this authorization shall be valid as the original By signature below, I/we affirm my/our identity as the respective individuals identified in the application received.

Company Name*
Principal (Required)*
Title*
Date*
 

* = Required fields

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