US Financial Group
3520 Patrick Street, Suite 216, Lake Charles, LA 70605
Phone: 337-474-2352    Fax: 337-478-3697

CREDIT APPLICATION
(Please Print or Type All Information)

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Business Information

Name of Business: ________________________________________________________

Doing Business As: _______________________________________________________

Business Type: __ Sole Proprietorship __ Partnership __ LLC __ Corporation

Date Incorporated: _____________ Federal ID No: __________________________

Years Under Same Ownership: ______     Years of Related Experience: ______

Phone Number: _______________________ Fax Number: ________________________

Describe Business: _______________________________________________________

Physical Address:  _______________________________________________________

Mailing Address:   _______________________________________________________

Previous Address:  _______________________________________________________

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Current Residence

Home Status: __ Buying __ Renting __ Paid For    Years at Residence: _____

Mortgage Company: ________________________________________________________

Amount of Monthly Payment: _________ Phone Number: _______________________

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Bank References - 2 Year History Required

1. Bank Name: __________________________________ Date Opened: ____________

Account No: _______________________________ Phone: _______________________

2. Bank Name: __________________________________ Date Opened: ____________

Account No: _______________________________ Phone: _______________________

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Trade and Finance References

1. Reference: _____________________________________ Years of Credit: _____

Contact: __________________________________ Phone: _______________________

2. Reference: _____________________________________ Years of Credit: _____

Contact: __________________________________ Phone: _______________________

3. Reference: _____________________________________ Years of Credit: _____

Contact: __________________________________ Phone: _______________________

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Equipment Vendor

Vendor: _________________________________ Contact: _______________________

Address: __________________________________ Phone: _______________________

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Equipment to be Leased or Financed

Describe Equipment: ______________________________________________________

Funding: ___ Leasing is Requested ___ Financing is Requested ___ Undecided

Term: ____ Months - Buy Out: ___ $1.00 ___ 10% or Other: _________________

Total Equipment Cost - Do Not Include Without Taxes: _____________

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This application is given for the purpose of obtaining credit. I hereby certify under penalty of law that the foregoing is a true and complete statement of my/our financial condition. In the event of any material change in my/our financial condition, I will notify US Financial Group immediately in writing. I understand that individual credit histories may be a determining factor in the evaluation of this application and I grant US Financial Group permission to obtain a personal credit report on all of the individuals that are listed above.




Date: _________________ Signature: _______________________________________