| Lessee Company Information |
| Company Name: |
{$form.company_name|htmlspecialchars} |
| Company Address: |
{$form.company_address|htmlspecialchars} |
| City, State, Zip: |
{if $form.company_city != ''}{$form.company_city|htmlspecialchars}{else}n/a{/if}, {if trim($form.company_state) != ''}{$form.company_state|htmlspecialchars}{else}n/a{/if}, {if $form.zip != ''}{$form.zip|htmlspecialchars}{else}n/a{/if} |
| Country: |
{$form.company_country|htmlspecialchars} |
|
| Signer's Name: |
{$form.signer_name|htmlspecialchars} |
| Title: |
{$form.signer_title|htmlspecialchars} |
| Phone: |
{$form.company_telephone|htmlspecialchars} |
| Fax: |
{$form.company_fax|htmlspecialchars} |
| State/Province: |
{$form.province|htmlspecialchars|nl2br} |
| Years In Business: |
{$form.year_business|htmlspecialchars|nl2br} |
|
| No: Of Employees: |
{$form.no_employees|htmlspecialchars} |
| Type Of Business: |
{$form.busines_type|htmlspecialchars} |
|
| Information of Officers, Partners or Guarantors |
| Name: |
{$form.partner1_name|htmlspecialchars} |
| Title: |
{$form.partner1_title|htmlspecialchars} |
| Social Security: |
{$form.partner1_ssn|htmlspecialchars} |
|
| Ownership: |
{$form.partner1_ownership|htmlspecialchars} |
| Home Address: |
{$form.partner1_address|htmlspecialchars} |
| City: |
{$form.partner1_city|htmlspecialchars} |
|
| State: |
{$form.partner1_state|htmlspecialchars} |
| Zip: |
{$form.partner1_Zip|htmlspecialchars} |
| Phone: |
{$form.partner1_Phone|htmlspecialchars} |
|
| Company Bank Reference |
| Name Of Bank: |
{$form.name_of_bank|htmlspecialchars} |
| Telephone: |
{$form.bank_telephone|htmlspecialchars} |
|
| Branch Location: |
{$form.bank_location|htmlspecialchars} |
| Contact Officer: |
{$form.bank_contact_officer|htmlspecialchars} |
|
| Checking Account: |
{$form.bank_checking_account|htmlspecialchars} |
|
| Trade References 2 Year History |
| Name of Supplier: |
{$form.name_of_supplier|htmlspecialchars} |
| Telephone: |
{$form.trade_telephone|htmlspecialchars} |
|
| City: |
{$form.trade_city|htmlspecialchars} |
| Contact: |
{$form.trade_contact|htmlspecialchars} |
|
| State: |
{$form.trade_state|htmlspecialchars} |
|
| Lease Loan Reference |
| Name: |
{$form.lease_loan_reference_name|htmlspecialchars} |
| Telephone: |
{$form.lease_loan_reference_telephone|htmlspecialchars} |
|
| Original Amount: |
{$form.lease_loan_reference_orignal_amount|htmlspecialchars} |
| Contact Person: |
{$form.lease_loan_reference_contact|htmlspecialchars} |
|
| Loan Account: |
{$form.lease_loan_reference_loan_account|htmlspecialchars} |
|
| Equipment Description |
| Make: |
{$form.equipment_make|htmlspecialchars} |
|
| Model: |
{$form.equipment_model|htmlspecialchars} |
|
| Year: |
{$form.equipment_year|htmlspecialchars} |
|
| Equipment Cost |
| Cost: |
{$form.equipment_cost|htmlspecialchars} |
|
|
|
| Applicant Details |
| Applicant: |
{$form.declare_applicant|htmlspecialchars} |
|
| Title: |
{$form.declare_title|htmlspecialchars} |
|
| Date: |
{$form.declare_date|htmlspecialchars} |
|