Westbury Customer Application

Business Name*

Business Contact*

First Last

Phone Number*

Email Address*

Website

Business Mailing Address*

Street Address Address Line 2 City State ZIP Code

Business Type

Number of Employees

Annual Sales

Years in Business

Ownership

Business Structure

Proprietorship
Partnership
Corporation

Federal Tax ID*

First Principal

Name of First Principal

First Last

Title

% Ownership

Social Security Number

Phone Number

Home Address

Street Address City State ZIP Code

Is There More Than One Principal?

Yes
No

Second Principal

Name of Second Principal

First Last

Title

% Ownership

Social Security Number

Phone Number

Home Address

Street Address City State ZIP Code

Equipment

Vendor

Phone Number

Contact

First Last

Equipment Condition

New
Used

Equipment Description

Equipment Cost*

Desired Loan Term

Estimated Credit Score

300 - 600
601 - 650
651 - 700
700+

Comments

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Westbury Application

Ownership

First Principal

Second Principal

Equipment