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CFG application - 2025 - Curtis Funding Group, LLC
- 1. CREDIT APPLICATION FORMPH: 248.238.7214 FAX: 888.548.9213 Email: cmac@curtisfunding.com BUSINESS INFORMATION BUSINESS NAME FED TAX ID #: INCORPORATION DATE: # OF EMPs TRADE NAME IF DIFFERENT FROM ABOVE, or DBA: PRIMARY CONTACT: EMAIL: Direct PH (if different): WEBSITE: TYPE OF BUSINESS (Corporation, Proprietorship, LLC, Other): PHONE # BUSINESS ADDRESS: CITY: STATE: ZIP: FAX # OWNERSHIP INFORMATION SHAREHOLDER/PARTNER/OWNER (1) % OWNERSHIP IN COMPANY TITLE: EMAIL ADDRESS SOC SEC # HOME ADDRESS: DO YOU OWN OR RENT? CITY: STATE: ZIP CODE: CELL PHONE # SHAREHOLDER/PARTNER/OWNER (2) IF APPLICABLE % OWNERSHIP IN COMPANY TITLE: EMAIL ADDRESS: SOC SEC # HOME ADDRESS: DO YOU OWN OR RENT? CITY: STATE: ZIP CODE: CELL PHONE # EQUIPMENT INFORMATION LIST A SUMMARY OF THE EQUIPMENT TO BE FINANCED: VENDOR / SUPPLIER W/ CONTACT INFO PRICING NEW / USED INSTALL LOCATION (IF DIFFERENT): COMPANY BANK INFORMATION ** ** To expedite application process, please include last 3 monthly summaries of business checking acct (page showing avg balance & acct #) INSURANCE / ACCOUNTING INFORMATION* INSURANCE AGENCY Contact name: Phone: ACCOUNTING FIRM Contact name: Phone: ADDITIONAL INFORMATION If application is for more than $50,000, or if company is younger than four years, additional information may be requested, such as two year-end financial statements and the latest interim statements on the company, and/or personal financial statements on the owners. Other information may be requested prior to final approval. If there is additional information available, that you would like to provide to help us reach a favorable decision, please feel free to submit with this application. Thank you… AKNOWLEDGEMENT & CONSENT By signing this form, the signor (s), who is a principal of the credit applicant, confirms that the information you have given to Curtis Funding Group, LLC, in respect of this application is true and complete, and you authorize us to rely on and use this information in order to confirm your identity, evaluate your credit worthiness, in relation to the financing transaction being contemplated. In particular, you agree that we, our affiliates and any third parties acting for us or on our behalf (hereinafter collectively “us”, “we” or “our”), may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor, and may hold, use, exchange and disclose such information for the purposes identified above. If your application is approved, you authorize us to collect, hold, use, exchange and disclose your personal information as required, in order to administer your contract, determine your insurance eligibility, and secure the assets being financed, or as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. All owners (10% or more) MUST sign X__________________________________________________________ SIGNATURE DATE __________________________________ PRINTED NAME X_________________________________________________________ SIGNATURE DATE __________________________________ PRINTED NAME Use separate, or additional, authorization if needed PH: 248.773.7580 FAX: 888.548.9213 Dave Gaddis PH: 269.657.6384 FAX: 888.548.9213 Phil Tarchala PH: 734.527.6514 FAX: 888.548.9213 Owen Davis Curtis Funding Group, LLC 61 Oakwood Dr., Coldwater, MI 49036 FOR EQUIPMENT LEASE OR EQUIPMENT FINANCE AGREEMENT PH: 888.510.1355 FAX: 734.977.7082 info@curtisfunding.com BIRTHDATE: BIRTHDATE: