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Commercial Credit Application
Prefer a paper application? Click Here.
Len Baccaro
Phone: 281.902.1931
Mobile: 201.650.0743
 
 
COMPANY INFORMATION
Business Legal Name:  DBA (if applicable): 
Address:  City:  State:  Zip:  Phone: 
Contact First Name:  Contact Last Name:  Title: 
Email:  Cell:  Federal Tax ID:  # of Employees: 
Date Under Current Ownership:  Web URL: 
Industry Type: 
Legal Structure: 
VENDOR, EQUIPMENT, AND FINANCE INFORMATION 
VENDOR CODE: 
 
Vendor Name:  Contact First Name:  Contact Last Name: 
Address:  City:  State:  Zip:  Phone: 
Web URL: 
 Email: 
NEW/USEDEQUIPMENT TO BE FINANCED$ FINANCED
Equipment Address:
(If Different From Company Address) 
 City  State  Zip 
TERM: (In Months) 
BANK AND FINANCE REFERENCES
Bank
Name
Account
Number
Contact
Name
Phone
Number
Finance
Company
Lease/
Loan #
Contact
Name
Phone
Number
OWNERS, OFFICERS OR GUARANTORS
1. Legal First Name:  Legal Last Name:  Title: 
Email:  Social Security #:  % Ownership:  Cell: 
Home Address:  City:  State:  Zip: 
Home Phone: 
2. Legal First Name:  Legal Last Name:  Title: 
Email:  Social Security #:  % Ownership:  Cell: 
Home Address:  City:  State:  Zip: 
Home Phone: 
3. Legal First Name:  Legal Last Name:  Title: 
Email:  Social Security #:  % Ownership:  Cell: 
Home Address:  City:  State:  Zip: 
Home Phone: 
DECLARATION/RELEASE
By clicking "Submit", the applicant and the Owners/Partners/Members/Guarantors agree as follows:
They certify that all information provided is true, correct and complete and that the property leased or acquired with any credit provided will be used solely for business and commercial purposes. The applicant and the Owners/Partners/Members/Guarantors of the applicant listed above recognize that their individual credit histories may be a factor in the evaluation of the applicant for the credit it is applying for and, thus, authorize Ascentium Capital LLC or its designee to investigate their organizational and personal credit histories. This includes obtaining information from all sources including using their consumer credit reports in the credit evaluation and collection processes, and to update any such information periodically.