Business Equipment Lease & Purchase

Business Questionnaire

Legal Business Name: *

Business Type: *

Corp
LLC
Sole
Partner

Ownership %: *

Federal Tax ID Number *

Business Start Date *

Industry Description: *

Length of Ownership (years): *

Business Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone Number: *

Business Phone #:

Business Website:

must start with http:// or https://

Owner Information

Owner Legal Name: *

First

Last

Owner Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Email: *

Date of Birth: *

Social Security #: *

Last 3 Months Business Bank Statements Upload

Use PDF, JPG or PNG formats only

Drivers License Upload

Equipment Vendor Invoice Upload

If you are not able to upload your documents, you can email them to sales@paramountpayment.com

Authorizations Signature *

Date Signed: *

By signing above, the Merchant and its owners /principals: (1) certify that all information and documents submitted in connection with this application is true, correct and complete; (2) authorize Paramount Payment Systems, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners and principals from third parties to verify any information provided on the application.