Referral Agent Application

REFERRAL AGENT CONTACT INFORMATION
BUSINESS BACKGROUND
Type of Business*:
Corporation
Sole Proprietorship
LLC
Partnership
Other
EQUIPMENT FINANCED
 
Type of Equipment
# of Units Financed Annually
Av. Price of Each Unit Financed
Transportation
(over-the-road)

Transportation
(vocation vehicles)

Construction

Manufacturing

Medical

Materials Handling

Agricultural

Other
CURRENT FUNDING SOURCES

THE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION CORRECT AND BY SIGNING BELOW, CONSENTS TO THE OBTAINING, FROM ANY CREDIT REPORTING AGENCY OR CREDIT GRANTOR SUCH INFORMATION AS NORTH MILL EQUIPMENT FINANCE, LLC. MAY REQUIRE AT ANY TIME IN CONNECTION WITH THIS APPLICATION.