Vehicle Wash Credit Application

COMPANY INFORMATION

Borrower's Legal Name

d/b/a

Street Address

City

State

Zip Code

County Federal Tax ID #  
Business Phone Fax Home Phone

Corporate Name for New Location
(if applicable)

Address of New Car Wash/
Equip Location

City

State

Zip Code
Company Structure  
Year Started State Registered

 

TRANSACTION INFORMATION
Loan Amount Term
Est. Funding Date End of Lease
Use of Finance Proceeds for Transaction   If Renovation, # Years
in Business
Attached to Gas Station   If yes, provide the monthly gallons sold and brand

 

PRINCIPAL (S) INFORMATION   (Please furnish the following for all principals)
Name Home Address    Title
SS # City/St/Zip % Ownership
Exp. (yrs) in Car Wash Business # of Car Washes Currently Owned  
Name Home Address Title
SS # City/St/Zip % Ownership
Exp. (yrs) in Car Wash Business # of Car Washes Currently Owned  
Name Home Address Title
SS # City/St/Zip % Ownership
Exp. (yrs) in Car Wash Business # of Car Washes Currently Owned  

 

BANK
Name of Primary Bank Contact
Account Number Phone  # of Years
Other Lender Reference Account Number Phone

 

OIL COMPANY REFERENCES (if applicable)
Name Contact
Account Number Phone

 

CAR WASH INFORMATION
Car Wash Address Attached to Gas Station Date Acquired
Legal Name
of Entity
Year Car Wash Established Purchase Price
Financed By Year Lease Expires   Landlord
Name & Address
Pretax Income 2005 2006 Monthly Debt Service        
Car Wash Address Attached to Gas Station Date Acquired
Legal Name
of Entity
Year Car Wash Established   Purchase Price
Financed By Year Lease Expires   Landlord
Name & Address
Pretax Income 2005 2006 Monthly Debt Service        
Car Wash Address Attached to
Gas Station
  Date Acquired
Legal Name
of Entity
Year Car Wash Established   Purchase Price
Financed By Year Lease Expires   Landlord
Name & Address
Pretax Income 2005 2006 Monthly Debt Service        

 

AUTHORIZATION FOR DISCLOSURE OF CREDIT INFORMATION

Because I have applied to Petroleum & Franchise Capital (PFC)  for financing, I hereby authorize you to disclose to PFC the personal and/or business
set forth in
attached enclosures.  I hereby represent to PFC that such information is true, correct and complete.  A photostatic copy of this authorization
shall be valid as the
original.  This authorization will expire ninety (90) days from the date set forth below.

If my application for business credit is denied, I have the right to a written statement of the specific reasons for denial.  To obtain the statement, I will
contact
Operations Manager, PFC, 33 Mill Plain Rd., Danbury, CT  06811 or call (203) 778-1000 within 60 days from the date I am notified of your
decision.
You will send me a written statement of reasons for the denial within 30 days of receiving my request for the statement.

Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, age, (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant’s
income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.  The federal agency that administers compliance with the law concerning the creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

The undersigned agrees that PFC has the right to confirm the accuracy of the above referenced credit information and that PFC has the right to
accept or
reject this lease application. I irrevocably authorize you to execute and file any UCC financing statement in your name which relates
to this transaction.

 

Please read the following terms and conditions carefully before submitting application. This is a legal document between PFC and you. 

1.General. 
This agreement, together with any such additional terms and conditions, are hereinafter referred to as this “Agreement”. PFC reserves the right, in its discretion, to
change or modify all or any part of this Agreement at any time, effective immediately upon the posting thereof on the Web Site. You are responsible for regularly reviewing these terms and conditions. If at any time you find that the terms and conditions of this Agreement are no longer acceptable, you should immediately cease all use of the Service. 

2. I hereby understand that by submitting this form I am executing this Agreement with PFC and accept all of the terms and conditions of this Agreement
and agree to be legally bound thereby.