Credit Application for US Atm Nework ATM Lease

Secure ATM Leasing Credit Application for US ATM Network

PHONE: 877-637-7770
Applicant
**A personal guarantee and a credit check with a minimum 650 fico score are required.**
Full Name*

First NameLast Name
Present Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years at Address
Home Phone Number*

Area CodePhone Number
E-mail*
Birth Date*

MonthDayYear
SSN*
Drivers License Number*
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years at Previous Address
Nearest Relative not living with you*
Relation*
Business Information where the ATM will be placed
Name of Business*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Type of Business*
Daily foot traffic*
Years in Business*
Business Tax id number*
Business Gross per month*
Have you or any entity you have owned ever had a judgement or lien filed against you? If so when?*
Have you any entity you have owned ever filed Bankruptcy of any type? If so when?*
Co-Applicant (if applicable) ** all fields are required **
Full Name

First NameLast Name
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years at Address
Home Phone Number

Area CodePhone Number
Birth Date

MonthDayYear
SSN
Drivers License Number
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years at Previous Address
Present Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Phone Number

Area CodePhone Number
Occupation
Supervisor
Years of Service
Salary per Month
Click to edit

NetGross
Other Income
Source
Have you ever filed for bankruptcy, if yes when?
Housing
Own or Rent?*

OwnRent
Everything I have entered in this application is true to the best of my knowledge, and is
an accurate statement of my obligations and the income upon which I will rely on to pay the
credit requested. I understand that you will rely on this information in deciding whether or
not to grant or continue credit to me. I also understand that you will retain this information
whether or not my application is approved. You are authorized to check my credit
and employment history.
Electronic Signature of Applicant*
Date*

MonthDayYear
Electronic Signature of Co-Applicant
Date

MonthDayYear
Number
Type a question
Should be Empty:

Secure ATM Leasing Credit Application for US ATM Network

Applicant

Business Information where the ATM will be placed

Co-Applicant (if applicable) ** all fields are required **

Housing

Co-Applicant (if applicable) all fields are required