SANTIAM ENTERPRISES CREDIT APPLICATION
Phone: 1-800-282-2793,  Fax: 1-503-859-2663

Company Information

Company Name Your Name Address City Country State Zip Phone Fax Tax ID# Type of Business: Non-Profit, Partnership, Proprietorship, Corp. No. of Employees Yrs. in Business Yrs. Industry Exp. Mgmt. in place since

Bank References (Two Year History)

Name of Bank/Brach How Long? Checking Account No. Loan Account No. Telephone No. Contact Officer Name of Bank/Brach How Long? Checking Account No. Loan Account No. Telephone No. Contact Officer Name of Bank/Brach How Long? Checking Account No. Loan Account No. Telephone No. Contact Officer Ever Been Bankrupt? Ever Had a Repossession? Are any Taxes Currently Past Due?

Trade References (Two Year History) & Current Contracts

Name of Supplier City/State Telephone No. Contact Person Name of Supplier City/State Telephone No. Contact Person Current Contract: Current Contract: Current Contract: Current Contract:

Personal Information on Officers, Partners, or Guarantors

Name Title Social Security No. Driver's License No. Home Address City State Zip How Long? Home Phone No. Other Phone No. Own or Rent Present Home? Previous Address City State Zip Name of Relative/Acquaintance Not Residing w/you Relationship Telephone No. Their Address City State Zip I/we hereby authorize you to whom this application is made, or your agents, to investigate my/our credit worthiness and will provide financial statements, tax returns, etc., as you deem necessary.  By the execution of the lease or finance agreement, I/we warrant and swear that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information.  Further, I/we warrant it is understood that Lessor/Financier reserves the right to reverse any credit decision if the information contained herein is found to be incorrect, and I/we will indemnify Lessor/Financier for any and all cost incurred with this application for credit including any cost incurred in the placement or reservation of the intended leased/financed equipment based on the information contained herein. Signature: Print Name: Date: