Business Application

Property Name:

Company Name:

(Please list corporation or LLC if applicable)

Physical Address:

Mailing Address:

Phone:

Fax:

Accounting Contact:

Your Title:

Bank Reference

Bank Name:

Location:

Phone:

Bank Official:

Account Number:

Trade References

Name:		Location:
Phone:

Name:		Location:
Phone:

Name:		Location:
Phone:

I hereby certify that the information given above is correct and valid, and that I am a legal authorized agent for the above named company. I authorize Southern Furniture Leasing, Inc. to contact the above references and any others that may be of value in reviewing this application. I acknowledge responsibility for any collection costs incurred by Southern Furniture Leasing, Inc. should default on any payment occur. A service charge of 2% per month may be added for unpaid invoices.

By submitting this electronic application I hereby agree to the above stated terms. I grant permission to Southern Furniture to process my application using banking and credit history and other information they deem necessary as provided by law.

I Agree