North Shore Leasing and Funding Corp.

You can complete the onilne application below or print the application and fax it to us at 631-231-3773.
Credit Application for Printing (pdf version)

Online Credit Application

Business Information
Exact Legal Company Name*		Business Type (Please Select)
DBA (if applicable)		Yrs. in Business*
Business Address*		Term (PLease Select)
City		State
Zip	-	Contact Person*
Business Phone# *		Business Fax #
Business Description (Please Select)		Cell Number
Fed Tax ID#		E:Mail

Personal Information (Include all owners to account for 100% of company ownership)
Principal Name		Last 4 digits of the SS#
Title		Ownership %
Address		City
State (Please Select)		Zip Code

Personal Information 2
Principal Name		Last 4 digits of the SS#
Title		Ownership %
Address		City
State (Please Select)		Zip Code

Personal Information 3
Principal Name		Last 4 digits of the SS#
Title		Ownership %
Address		City
State (Please Select)		Zip Code


Equipment Information
Description		Equipment Cost
Equipment Status (Please Select)		If used or refurbished - Age of Equipment

Supplier Information
Supplier Name		Contact
Phone #		Cell #
Address		E:Mail

* Indicates Required Fields
AUTHORIZATION TO OBTAIN CREDIT INFORMATION Applicant warrants all credit and financial information submitted to North Shore Leasing & Funding, Inc. (here after referred to as NSL&F Inc.) and/or its assignees to be true and accurate and hereby authorizes all banking institutions and credit reporting agencies to release necessary information via telephone, mail, Internet or facsimile as requested for purposes of making a credit decision. The undersigned individuals specifically authorize NSL&F Inc and/or it assigns to obtain personal credit bureau reports for making, extension, or renewal of this credit decision or collection of the resulting account. A fax or photocopy if this authorization shall be valid as the original. Entering your name in the box below serves as your digital signature certifying that the facts contained in this application are true and complete to the best of your knowledge and that you have read and understand the authorization above. Name of Applicant: (required) Date: (required)

Printer Friendly Application

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Credit Application (pdf version)


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