Company Information

Equipment Information

Principal Ownership Information

*By signing above, I (we) affirmatively state and agree to the terms of the credit release authorization below

Credit Release Authorization

I (we) hereby certify that the information contained in this credit application is true and accurate and I (we) hereby authorize: i) both my and our banks, trade
references, and financial institutions the right to release credit information; and ii) AILCO, or its designee, to obtain financial information including, consumer or other credit reports related to both my and our company’s credit history or credit profile, and to update that information hereafter so long as any amount owed, by the company or guaranteed by me, to AILCO is outstanding. A copy of this application received electronically or by facsimile shall be considered as
an original.
ECOA NOTICE: If your application for commercial credit is denied, you have the right to a written statement of the specific reasons for that denial. To obtain that statement, please write to us at: W222N833 Cheaney Rd., Waukesha, WI 53186 within 60 days from the date that you were notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of receiving your request for the statement. PLEASE NOTE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating on the basis of race, color, religion, national origin, sex, marital status, age (provided the
applicant has the capacity to enter the binding contract), all or part of the applicant’s income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. You agree, in order for us to service our account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable.

[field id="Company_Legal_Name"]
[field id="Federal_Tax_ID"]
[field id="Entity"]
[field id="DBA_(If_Any)"]
[field id="Primary_Contact"]
[field id="Title"]
[field id="Company_Phone"]
[field id="Cell_Phone"]
[field id="Fax"]
[field id="E-Mail_Address"]
[field id="Company_Street_Address"]
[field id="City_State_Zip"]
[field id="Company_Mailing/Billing_Address"]
[field id="City_State_Zip_company_mailing"]
[field id="Date_Company_Started"]
[field id="Years_Under_Current_Ownership"]
[field id="Nature_of_Company"]
[field id="Primary_Bank"]
[field id="Contact"]
[field id="Phone_#"]
[field id="Checking_Account_#"]
[field id="Revenues"]
[field id="Contact"]
[field id="Insurance_Agent"]
[field id="Insurance_Phone_#"]
[field id="Equipment_Description"]
[field id="Requested_Term"]
[field id="Tax_Exempt?"]
[field id="Company_Street_Address"]
[field id="City_State_Zip"]
[field id="Vendor_Name_&_Address"]
[field id="Vendor_Contact_&_Phone"]
[field id="Principal_Name_poi"]
[field id="Principal_Title_poi"]
[field id="%_of_Ownership_poi"]
[field id="Social_Security_#_poi"]
[field id="Date_of_Birth_poi"]
[field id="Home_Phone_#_/_Cell_Phone_#_poi"]
[field id="Home_Address_poi"]
[field id="City_State_Zip_poi"]
[field id="Principal_Name_poi"]
[field id="Principal_Title_poi"]
[field id="%_of_Ownership_poi"]
[field id="Social_Security_#_poi"]
[field id="Date_of_Birth_poi"]
[field id="Home_Phone_#_Cell_Phone_#_poi"]
[field id="Home_Address_poi"]
[field id="City_State_Zip_poi"]
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