Secure Online Credit Application

CNC Associates, Inc.
Haas Automation Leasing/Financing
2900 Challenger Place
Oxnard, CA 93030
Telephone (888) 350-4CNC
Fax (805) 278-8501
  
 

  COMPANY INFORMATION 

Legal Name of Applicant: DBA: Date Established:
Business Address:
City: State: Zip:
Telephone: Fax:
Proprietorship L.L.C. Partnership Corporation State of Incorporation  
Contact Person: Valid Email:

   EXISTING EQUIPMENT FINANCED WITH   

Name: Acct No: Phone:
Name: Acct No: Phone:
Name: Acct No: Phone:

   PRINCIPALS   

Name    Name 
Title    Title 
%Ownership    %Ownership 
Home Address    Home Address 
Soc. Sec.#    Soc. Sec.# 

   EQUIPMENT INFORMATION   

  Haas Machine Model:

New

Used
 Haas Dealer: Contact:
 Equipment Cost: $ Down Payment: $

AUTHORIZATION FOR RELEASE OF CREDIT INFORMATION

By submitting this form I / we understand that I / we authorize any reference listed above and any credit reporting agency to release to CNC Associates, Inc. any and all information which, in its sole discretion, CNC Associates, Inc. deems necessary to process this application for credit. I / We affirm that all financial and other information I / we have provided with regard to this application is true and correct as of the day I / we provided it.

  Title:
  		Name:
  		 

                                                                         

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