EzLane Auto Auctions Inc.
Financial Information Request
Type of EntityDate
As Partner or President of the Company I am applying for this Floor-plan Line, completing and signing this application.
______________________________________________________/______________________/____________________
Company Legal NameTax ID NumberSales Tax Number
______________________________________________________/______________________/____________________
If DBA, List DBA NameTax ID NumberSales Tax Number
____________________________________/_________/_______/____________________/_______________________
Business Address CityStateZipBusiness PhoneBusiness Fax
____________________________________/________/________/____________________________________________
Mailing Address CityStateZipBusiness Email Address
1._____________________________________________/_______________________________/___________________
Names of Company Partners or Officer if Inc.Driver's License NumberExpiration Date
_________________/____________________________/__________________/_________________________________
Date of BirthSocial Security NumberCell Phone NumberPersonal Email Address
2._____________________________________________/_______________________________/___________________
Names of Company Partners or Officer if Inc.Driver's License NumberExpiration Date
_________________/____________________________/__________________/_________________________________
Date of BirthSocial Security NumberCell Phone NumberPersonal Email Address
3._____________________________________________/_______________________________/___________________
Names of Company Partners or Officer if Inc.Driver's License NumberExpiration Date
_________________/____________________________/__________________/_________________________________
Date of BirthSocial Security NumberCell Phone NumberPersonal Email Address
1 of 4
Do you Own or Rent?
Business Location
Home Location
Business Type:
Years in Business
Years at current location
License Number:
F/P limit requested $
Name 3 Business Reference:
__________________________________________________________________________________________________
Company NameBusiness TypePhoneWho is your contact here?
__________________________________________________________________________________________________
Company NameBusiness TypePhoneWho is your contact here?
__________________________________________________________________________________________________
Company NameBusiness TypePhoneWho is your contact here?
If this is a partnership both partners must give the following information and sign.
__________________________________/_________/______________________________________________________
Full Name Owner, Partner or PresidentOwnership %Personal AddressCityStateZip
__________________________________/__________/______________________________________________________
Full Name Owner, Partner or PresidentOwnership %Personal AddressCityStateZip
2 of 4
Authorization and Consent
The owner, partners, or officers hereafter the (Principles) hereby certify that the
information contained within this application is true, complete, and accurately
reported. The Principles herein authorize EzLane Auto Auctions Inc. hereafter
(PBAE) to obtain credit information and/or background information from credit
bureaus and any financial institution or trade creditor that the Principles
have provided or any other source which PBAE deems appropriate and necessary. Principles
also authorize PBAE to contact any third parties and to disclose information limited
to assessing Principles credit worthiness, collection of any outstanding debt,
and obtaining any prior financial agreements as to perfect PBAE's Blanket
Security Agreement further, if credit is granted, Principles
authorize PBAE to review Principles account periodically, which could include
obtaining additional credit reports. Principles authorize PBAE to disclose my
credit information into any credit database. Principles authorize PBAE, to
call, fax, email or text Principles for the purposes of including, but not
limited to marketing, collection and any other communication needs. Principles
understand and agree that this application will not be complete until PBAE
receives the information it regularly obtains and considers when it evaluates
applications for the amount and type of floor-plan Principles are requesting.
PBAE will notify Principles if it requires Principles to provide any
information or documents in addition to those expressly requested by this
application.
The Floor-plan Line Collateral Is a Blanket Security Agreement sent after application approval for your review and signature.
Please review your application information before printing and signing.
I HAVE READ THE AUTHORIZATION AND CONSENT AND I UNDERSTAND AND AGREE TO THESE TERMS.
________________________________________/________________________________________/________________
Owner, Partner or Presidents NameSignatureDate
________________________________________/________________________________________/________________
Owner, Partner or Presidents NameSignatureDate
A clear copy of Owner, Partner or officers driver's License's must accompany this Application.
After completing this application please print and fax to 217-935-9600 or mail to:
EzLane Auto Auctions
301 S Side Square
Clinton IL. 61727
After your application is approved we will email you our Demand Promissory Note and Security Agreement. Please complete and sign the security agreement and mail to:
EzLane Auto Auctions
301 S Side Square
Clinton IL. 61727
3 of 4
Date
Formal request for and authorization to release Information
I
Principle of
am authorizing EzLane Auto Auctions Inc. to receive answers to and my bank listed below to respond to the following questions.
Bank Name:
Bank Contact:
Bank Contacts Email:
Account #:
Bank Phone
Bank Fax
Information Requested:
Is this account in good standing and current with all its obligations to your bank? YES
NO
Has this account written any ISF checks in the past 24 months? YES
NO
What is the last 3 months' average balance pertaining to this account? $
Requested by: EzLane Auto Auctions Inc. Agent:____________________________________________________
Signature
Authorized by:
Principle: ________________________________________________
Signature
4 of 4