Leasing and Credit Application
Please complete the following fields and click submit.
After submitting, print out the form and fax to 414-276-8004.
Business Legal Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Year Started:
Corp
Sub-S
LLC
Partnership
Proprietor
Owners/Partners/Officers
Title
%Ownership
Address
Soc.Sec.No.
1.
%
2.
%
3.
%
Primary Business:
Carrier:
Common
Private
Contract
Authority:
Interstate
Intrastate MC/LC Number:
Current Fleet:
Tank trailers:
Qty:
Types of Trailers:
Tractors:
Qty:
Types of Tractors:
Credit applied for:
Service
Parts
Tank Finance
Lease
I am considering the following equipment for:
Lease
Financee No. of Months:
Make:
Model:
Qty:
Total Cost: $
Dealer:
Sales rep:
Phone:
What is the reason for
aquiring the tank trailers:
Company
Telephone
Contact
Account No.
Bank Reference:
Vendor and/or
Trade References:
1.
2.
3.
I/we hereby authorize Clement Finance & Leasing, Inc. (CFL)/Paragon to verify any credit information from whatever source it deems appropriate and further authorize our banks and trade references to release by telephone, e-mail or fax all credit information requested by Clement Finance & Leasing, Inc./Paragon Enclosed under separate cover or as an attachment to this e-mail application are financial statements (Income Statement, Balance Sheet and Cash Flow Statement) for the last two year end periods and interim period to date. Applicant hereby certifies that the information provided is accurate and correct to the best of my knowledge and that this information will be relied upon in the granting of financial credit by CFL/Paragon or its assigns. Please print out, sign, and fax a copy of this application to 414-276-8004.