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 Name Last Name
Present Residence Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Years at Address
Home Phone Number*

Area Code Phone Number
E-mail*
Birth Date*

Month Day Year
SSN*
Drivers License Number*
Previous Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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

City State / Province

Postal / Zip Code Country
Phone Number*

Area Code Phone 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 Name Last Name
Present Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Years at Address
Home Phone Number

Area Code Phone Number
Birth Date

Month Day Year
SSN
Drivers License Number
Previous Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Years at Previous Address
Present Employer
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone Number

Area Code Phone 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*

Month Day Year
Electronic Signature of Co-Applicant
Date

Month Day Year
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