Westbury Customer Application

Business Name*

Business Contact Name*

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/LLC

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

I authorize Advantage+ and its agents to investigate my business and personal credit.

Westbury Application

Ownership

First Principal

Second Principal

Equipment