Thank you for allowing First City Bancorp to provide your company with lease financing for your business equipment needs.

Please fill out the information requested below. You will be contacted by First City Bancorp immediately upon our receipt of completed application. Please fill out this form and fax it to us at (888) 237-6700.

All fields marked (*) are required.

  

 

Email Notifications  
   
   
Email Address:  
*  
   
   
Company Information  
   
   
Company Name: DBA:
*
   
   
Address: City:
* *
   
   
State: Zip Code:
* *
   
   
Contact Name: Home Phone: (Optional)
* (xxx-xxx-xxxx)
   
   
Work Phone: Extension:
*(xxx-xxx-xxxx)
   
   
Fax Number: Business Structures:
(xxx-xxx-xxxx)
   
   
Years In Business: Federal Tax ID:
* *
   
   
Lease Details:  
   
   
Amount: Equipment Description:
* *
   
   
Referred By:  
*  
   
   
Guarantor 1: Guarantor 2:
   
   
Generation: Generation:
   
   
First Name: First Name:
   
   
Last Name: Last Name:
   
   
Social Security Number: Social Security Number:
(xxx-xx-xxxx) (xxx-xx-xxxx)
   
   
Home Address: Home Address:
   
   
City: City:
   
   
State: State:
   
   
Zip Code: Zip Code:
   
   
Bank Reference:  
   
   
Bank Name: Branch:
*
   
   
Contact: Phone:
*(xxx-xxx-xxxx)
   
   
Account Name: Account Type:
   
   
Account Number:  
*  
   
   
Trade Reference 1:  
   
   
Business Name: Contact Name:
*
   
   
Phone Number: Account Number:
* (xxx-xxx-xxxx)
   
   
Trade Reference 2:  
   
   
Business Name: Contact Name:
*
   
   
Phone Number: Account Number:
* (xxx-xxx-xxxx)
   
   
Trade Reference 3:  
   
   
Business Name: Contact Name:
*
   
   
Phone Number: Account Number:
* (xxx-xxx-xxxx)
   


By checking this box, Applicant represents and warrants that all credit and financial information submitted to First City Bancorp is true and correct and First City Bancorp may obtain any information necessary pertaining to this application including, but not limited to owners, officers or guarantors. Applicant agrees to furnish financial statements upon request. Applicant authorizes First City Bancorp or any credit bureau or other investigative agency employed by First City Bancorp to investigate the references, statements or other data herein listed.

Your signature on a Credit Release Authorization form is required. Please click here to print the Credit Release Authorization form, sign and fax the printed copy to (888) 237-6700