LaserStar Workstations - micro welding applications and laser welding

Please type all application data onto the screen, print and then sign the application. This application has been formatted to be faxed for security purposes. Fax completed application to: 401-431-6131.

Company Legal Name & D.B.A. if applicable

Company Street Address


City	State	Zip


Telephone No.	Fax No.	Authorized Signer & Title

Company Bank Information

Bank	Branch	Type	Phone/Fax	Contact

Bank	Branch	Type	Phone/Fax	Contact

Bank	Branch	Type	Phone/Fax	Contact

JBT Rating

Trade References

Firm Name	Phone	Contact	How Long	High Credit

Firm Name	Phone	Contact	How Long	High Credit

Firm Name	Phone	Contact	How Long	High Credit


Business Landlord		Phone	How Long	Rent/Month

Personal Information Officer

First Officer	Title	Soc. Sec #	Ann. Income	Home Phone


Street Address


City	State	Zip


Own/Rent	How Long	Previous Home Address if Less Than Two Years

AUTHORIZATION

I/we hereby authorize to whom this application is made, or your agents, to investigate my/our credit worthiness. I/we warrant that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information. Further, I/we understand that the Lessor reserves the right to reverse any credit decision if the information is found to be incorrect.

Signature:

Date: