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OLEAF <br />CREDIT APPLICATION <br />Contact Sherri Heathman <br />Phone 877-895-0191 <br />Pnv 7R7-R7.rA7RR <br />TFIRMILEASE PAYMENT SCHEDULE: <br />Term (Months) Security DeposillAdvance payment (Check One Only) <br />Lease Enurcriase Caption (Check One Only) <br />i I ❑ Security Deposit (s): $ <br />[,� Advance Payment (s): ❑ FMV ❑ $t ❑ Other <br />CUSTOMER a <br />Lessee Name <br />Lessee P one Number E-mail <br />Monts Performing Arts Ctr <br />Lessee <br />Address <br />211 Of MLK Dr N <br />South Bend, IN 46601 <br />Signer Name <br />Tax ID <br />Nature of <br />�+t€e <br />Bus. <br />,.:£r Started <br />REFERENCES <br />Style of Business: <br />❑ Corporation El Partnership <br />Annual revenue: ©Over gt million <br />© Sde Proprietor ❑ P.C. ElL.L.C. <br />❑ tinder $1 million <br />Bank Reference <br />Account <br />No. <br />Bank Phone <br />Bank Contact <br />No. <br />Trade Ref- <br />Phone No. <br />Account No. <br />Contact <br />13ERSONAL INFORMATIONON a• a- OR <br />• <br />Name <br />Name <br />Title <br />Social <br />Title <br />social <br />Security No. <br />Security <br />Address <br />Address <br />County State <br />County <br />Zip <br />State Zip <br />AUTHORIZATION <br />e un ersigne n i ua s who is ei er a P nc pa , So a ropdetor, or Persona uaranlor of the Credit scant, recogn rang al s ar of R IVI ua ere 3t IS ory may e a ac or m e eva ua ono a cre It story a t e <br />Applicant or in the evaluation of his or her personal guaranty, if applicable, hereby consents to and authorized the use of a consumer credit report on the undersigned ltndividual(s) by the above named business credit grantor, from time to <br />lime as maybe needed, in the initial credit evaluation and subsequent review processes. <br />Ifwe stand advised that the Advance Payment or Security Deposit is not refundable unless this application is rejected by Lessor. <br />Partner, Proprietor or Guarantor <br />Partner, Proprietor or Guarantor <br />.X <br />ix <br />`ar application for business credit is denied, you have the tight to a written statement of the specific reasons for the denial. To obtain the statement, please cal (f)W)819-5556 Wthin 60 days front the dale you are noffed of our <br />ton. We v+ill send you a written statement of reasons for the denial vithin 30 days of receiving your request for the statement. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit <br />�'plicania on the basis of race, color, religion, national origin, sex, martial 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 pubic <br />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 lawconceming the creditor is the Federal Trade <br />Commission, Equal Credit Opportunity, Washington, D.C. 20560. <br />Please Fax to: 267-675-5786 <br />Or Email to: Sheatrnan cALEAFnow.com <br />