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PBT Loan Application
In order to best assist you, please complete all applicable items.
Questions? Call us at 925.768.1805.

Customer Information for Business and Industry
Full Legal
Company Name		 Type of
Business
Years in
Business
Annual
Sales
Billing
Address
Street Address
(if different)
City and
State
Zip Code
Work or
Main Phone
Home or
Other Phone
Fax
Phone
Number of
Employees
Business
Owner's Name
Title
Years
as Owner
Date of Birth
MM/DD/YY
Legal
Structure		 State of
Incorporation
Valid Email
(Required) 		Federal Tax
ID Number
 
Principal 1
Name		 Principal 1
Address
City, State,
Zip Code		 Email
Address
Social
Security No.		 Principal 1
Ownership %
 
Principal 2
Name		 Principal 2
Address
City, State,
Zip Code		 Email
Address
Social
Security No.		 Principal 2
Ownership %
Bank and Trade References (for Business and Industry Clients)
Bank 1
Name		 Bank 1
Phone
Account No. Contact
 
Bank 2
Name		 Bank 2
Phone
Account No. Contact
 
Trade Ref 1
Name		 Trade Ref 1
Phone
Account No. Contact
 
Trade Ref 2
Name		 Trade Ref 2
Phone
Account No. Contact
Equipment and Vendor Information (All clients to complete this section)
Vendor
Name		 Vendor
Contact
Vendor
Phone
Vendor
Fax
Purchase
Time Frame		 Estimated
Equip. Cost
Budget for
Equipment
Annual
Budget
Structure
Preference		 Payment
Options
Buyout
Options		 Specify
if Other
Additional
Comments
By pressing "Submit", Business and Industry applicants, in recognizing that his or her individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes Pointblank Business Technology and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the named applicants, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent.

I (we) certify that all of the information in this application is complete and accurate to the best of my (our) knowledge.

 

Incomplete applications may delay processing.  Contact PBT at (925) 768-1805 if you have any questions.