Rental Application Form - Commercial Credit Solutions

Please provide the following with this application:

"*" indicates required fields

COMPANY

Applicant *

Reg Nr *

Trading As *

Vat Reg Nr *

Select Entity Type *

Entity Type Other

Company Tel Nr *

Date Established *

Period Under Current Management *

Web Address *

Nature of Business *

Industry *

Bankers *

Branch *

Bank Account Type *

Bank Account Nr *

Date Account Opened *

Financial Year End Month *

Latest Financials Available (2024) *

Street Address *

Street Address Town *

Street Address Postal Code *

Street Address is the same as Postal Address

Postal Address *

Postal Address Town *

Postal Address Postal Code *

DIRECTORS - 1

Surname *

First Name *

Full Name *

ID Number *

Residential Address *

E-Mail Address *

Cell Nr *

Company Representative *

DIRECTORS - 2

Surname

First Name

Full Name

ID Number

Residential Address

E-Mail Address

Cell Nr

Company Representative

DIRECTORS - 3

Surname

First Name

Full Name

ID Number

Residential Address

E-Mail Address

Cell Nr

Company Representative

DIRECTORS - 4

Surname

First Name

Full Name

ID Number

Residential Address

E-Mail Address

Cell Nr

Company Representative

SHAREHOLDER 1

Same as DIRECTORS

% Share *

First Name *

Surname *

ID Number / Reg Nr *

Marital Status *

Owner? *

Residential Address *

SHAREHOLDER 2

Same as DIRECTORS

% Share

First Name

Surname

ID Number / Reg Nr

Marital Status

Owner?

Residential Address

SHAREHOLDER 3

Same as DIRECTORS

% Share

First Name

Surname

ID Number / Reg Nr

Marital Status

Owner?

Residential Address

SHAREHOLDER 4

Same as DIRECTORS

% Share

First Name

Surname

ID Number / Reg Nr

Marital Status

Owner?

Residential Address

Equipment 1

Make *

Model *

Quantity *

Value *

Serial/VIN

Equipment 2

Make

Model

Quantity

Value

Serial/VIN

Equipment 3

Make

Model

Quantity

Value

Serial/VIN

Equipment 4

Make

Model

Quantity

Value

Serial/VIN

Equipment 5

Make

Model

Quantity

Value

Serial/VIN

Supplier *

Purchase Price (Incl VAT) *

Deposit Amount (Incl VAT) *

Funding Requirement *

Term (Months) *

Electronic Signature Consent *

Rental Application Signed By *

Rental Application Signed By Capacity *

3 Months Bank Statements *

Case Flow Projection

COR14.3 *

Latest Financial Information

Shareholders ID's

Equipment Quote *

Shareholders confirmation

Escalation? *

Escalation %?