Credit Application
Fax to: 800-451-5360
NEC FINANCIAL SERVICES, INC.
300 FRANK W. BURR BLVD., TEANECK, NJ 07666 · (877) NEC-FINANCE · (201) 287-8300 · www.neclease.com
EXISTING CUSTOMER YES Ë
NO Ë If yes, Account #
FINANCIAL STATEMENTS MAY BE REQUIRED
Supplier Name and Address
Telephone
VENUS TELEPHONE d/b/a TELECO
(973) 746-3636
TION
88A LORRAINE AVENUE
Fax (973) 746-3630
MONTCLAIR, NEW JERSEY 07043
SUPPLIER
INFORMA
E-mail
Sales Rep Name
ANDREW TAUB
Contact Name ANDREW TAUB
andy@teleco4.com
Equipment Description (Make, Year, Model, Etc.)
Estimated Installation Date:_________________ Contact:_______________________________________________ Lease Signer:___________________________________________ Title:_______________________
TION
Lease Type
Lease Term
NEC Equipment Cost
$ _________________________
Lease Rate Factor
_________________________


Non-NEC Equipment
$ _________________________
Lease Payment
$ _________________________
LEASE INFORMA
Equipment Total
$ _________________________
(Lease Payment = Lease Rate Factor x Total Cost)
Sales Tax
$ _________________________ _______%
Advance Rentals
# ___________= $____________
Sales Tax
Rate
Total Cost
$ _________________________
Security deposit
$ _________________________
Complete Legal Company Name
Telephone
Fax Number
E-Mail
Trade Style/DBA
Nature of Business
Federal Tax ID# (FID)
Headquarters Address
City
State
Zip Code
Installation Address (if different from above address)
City
State
Zip Code
(Corporation Proprietorship General Partnership LTD LLC LLP PC PA Not for Profit Government
Business Start Date: __________________________________________ Bankruptcy History (Circle one): No
Yes/When: __________________________________________________________
Years Business Owned ____________________________ State of Inc./Organization__________________________________________ D & B# _____________________________________________
If you are Tax Exempt Please Attach Certificate/Exemption #
Parent Company (if applicable) Company:
Subsidiary Division Affiliate
Equipment Installation Location:
Name:__________________________________________________________________________________
Landlord/Owner: __________________________________________________________________________
HQ Address: ____________________________________________________________________________
Address:__________________________________________________________________________________
TION ____________________________________________________________________________________ _____
____________________________________________________________Expiration Date:______________
City, State, Zip: __________________________________________________________________________
Contact:_________________________________ Phone No.: ______________________________________
Name/Title : Principal
Owner
Partner
Officer
Member
Email
Email
Social Security #
Social Security #
CUSTOMER INFORMA
Home Address
City
State
Zip
Home Phone
Name/Title (Circle one): Principal
Owner
Partner
Officer
Member
Email
Social Security #
Home Address
City
State
Zip
Home Phone
Name of Bank / Branch
How Long
Contact Name
Telephone
Chkg. Acct. #
Fax
Loan Acct. #
Name of Trade Reference
How Long
Contact Name
Telephone (or City & State)
Account #
I / We grant NEC or its Agent's permission to investigate my/our financial responsibility and credit worthiness, and authorize release of any personal or business information accordingly. I / WE agree to make
available financial statements, tax returns, etc, upon request. I/We acknowledge that any Advance Rental(s) and/or Security Deposit(s) are not refundable if NEC approves our application for credit.
Signature: X_______________________________________________________________________________________________ Print Name:____________________________________________________________________________ Date:_______________
AUTHORIZED SIGNER
TITLE
By execution of the Credit Application and Lease Agreement, I / We warrant that the information submitted herein is true and correct.
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