Allied Financial Solutions
7103 Turfway Road Suite 306  Florence, KY 41042  Phone: (800) 543-4561  Fax:  (859) 525-8837
"Old Friends!  New Name!  Same Great Service!


Allied Financial Solutions
7103 Turfway Road Suite 306  Florence, KY 41042  Phone: (800) 543-4561  Fax:  (859) 525-8837
© 2003 Allied Financial Solutions.  All Rights Reserved.
APPLICATION FOR FINANCING
Allied Financial Solutions
7103 Turfway Road, Suite 306
Florence, KY  41042
(800) 543-4561
*Legal Name, as registered:
*Address:
*City:
*Zip Code:
*Phone:
Fax:
*State:
*Contact Name:
  *Title:
*Phone:
*Contact Email Address:
*Organization Number:
*State in which incorporated:
BUSINESS STRUCTURE
">
">
">
">
*Nature of business:
*Legal Form:
Date Business Started:
Date Present Ownership: 
Number of Employees:
Branches In:
  Federal ID#:
Full Time:
Part Time:
PRINCIPAL OWNERS / OFFICERS
">
">
">
">
Stockholder/Owner 1
Name:
Home Address:
City:
State:
Zip Code:
Phone:
Fax:
   Title:
Social Security Number:
Email Address:
Stockholder/Owner 2
Name:
   Title:
Social Security Number:
Home Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:
Stockholder/Owner 3
Name:
   Title:
Home Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:
Social Security Number:
CREDIT REFERENCES
">
">
">
">
Business Bank/Branch:
Account Number:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Business Bank/Branch:
Account Number:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Name:
Account Number:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Name:
Account Number:
Address:
City:
State:
Zip Code:
Phone:
Fax:
">
">
">
">
INSURANCE AGENT:
  Name:
City:
State:
Zip Code:
Phone:
  Address:
INITIAL FINANCING REQUEST
">
">
">
">
Type of Equipment to be Financed:
Vendor:
Approximate Amount:
Term (Months):
ADDITIONAL INFORMATION & SPECIAL REQUESTS
">
">
">
">
NOTICE:

To Allied Financial Solutions:  I/We grant Allied Financial Solutions or its Agents authorization to make all inquiries necessary in order to determine the credit worthiness of Applicant.  I/We certify that the information contained herein is true and correct. 
Press "Send" to submit form to Allied Financial Solutions
*Fields marked in red asterisks are required
">
">
">
">
NAME
Renee Lecatsas
Allied Financial Solutions
7103 Turfway Road Suite 306  Florence, KY 41042  Phone: (800) 543-4561  Fax:  (859) 525-8837
Proprietorship
Partnership
Sub S
Corporation
LLC
Principal
Owner
Partner
Officer
Principal
Owner
Partner
Officer
Principal
Owner
Partner
Officer