New Financing Application – Amthor International

Finance Application - 2015

Horizon Capital Services, Inc.
20 Osprey Lane – Gardiner, NY 12525
Brian Amthor – bramthor@amthorinternational.com
Phone : (845) 778 5576 Fax : (845) 633 8852
Applicant Full Legal Name*
First Last
Phone*
Fax No
Company Headquarters Office Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Tax ID Number/SSN*
Email*
Date of Birth*
MM slash DD slash YYYY
Type of Business*
- Corporation
- Limited Liability Company (LLC)
- Partnership
- Sole Proprietorship
State of Organization*
Country of Citizenship*
Years in Business/Year Started
Number of Employees:
Annual Revenue*
Nature/Type of Business Engaged in:*
Geographic Markets Served:
Types of Products Hauled or Industries Served:
Dealer Name/Supplier of Equipment
Dealer Phone
Dealer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dealer Fax
Purpose*
- New Equipment Purchase
- Used Equipment Purchase
- Growth
- Replacement
- Refinance
Approx. Delivery Date:
MM slash DD slash YYYY
Equipment Description (include model year, if used)*
Equipment Price*
Less Trade
Less Down Payment
Financed Amount*
Insurance Agent (Liability & Property)
Insurance Agent Phone
Type of Financing Desired*
- Loan
- Lease (Trac %)
- Lease (Fair Market Value/Operating Lease)
Lease/Loan Term*
- 36
- 48
- 72
- 84
Legal Owner/Guarantor Information
(Complete this section for all owners with 25% or more in company ownership)
Legal Owner/Guarantor #1
First Last
% Company Ownership
Please enter a number from 0 to 100.
Primary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Tax ID Number/SSN
Date of Birth
MM slash DD slash YYYY
Type of Business
- Corporation
- Limited Liability Company (LLC)
- Partnership
- Sole Proprietorship
State of Organization
Country of Citizenship
Section Break
Legal Owner/Guarantor #2
First Last
% Company Ownership
Please enter a number from 0 to 100.
Primary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Tax ID Number/SSN
Date of Birth
MM slash DD slash YYYY
Type of Business
- Corporation
- Limited Liability Company (LLC)
- Partnership
- Sole Proprietorship
State of Organization
Country of Citizenship
Section Break
Legal Owner/Guarantor #3
First Last
% Company Ownership
Please enter a number from 0 to 100.
Primary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Tax ID Number/SSN
Date of Birth
MM slash DD slash YYYY
Type of Business
- Corporation
- Limited Liability Company (LLC)
- Partnership
- Sole Proprietorship
State of Organization
Country of Citizenship
Section Break
Legal Owner/Guarantor #4
First Last
% Company Ownership
Please enter a number from 0 to 100.
Primary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Tax ID Number/SSN
Date of Birth
MM slash DD slash YYYY
Type of Business
- Corporation
- Limited Liability Company (LLC)
- Partnership
- Sole Proprietorship
State of Organization
Country of Citizenship
Related Companies
(Please indicate affiliation. Ex: Subsidiary, Common Ownership)
Company Name #1
Affiliation
Activities Conducted in what Countries?
Company Name #2
Affiliation
Activities Conducted in what Countries?
Company Name #3
Affiliation
Activities Conducted in what Countries?
Top Three Customers
(Haul Sources)
Name #1*
% of annual sales*
Since*
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Name #2
% of annual sales
Since
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Name #3
% of annual sales
Since
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Banking Reference
Bank*
Business and/or Personal Acct No.*
Contact Name*
Phone No.*
Operating Line with
Approved Amount
Outstanding Amount
Contact
Phone No.
Finance Companies (List your major creditors)
If business relationship is with Wells Fargo, what types of accounts are open?

(i.e. deposit, treasury services, etc.)
Fleet Statistics
Number of Trucks Owned
Number of Trucks Leased
Number of Trucks Rented
Owner/Operators
Total Number of Trucks
Average Age
Number of Trailers Owned
Number of Trailers Leased
Number of Trailers Rented
Owner/Operators
Total Number of Trailers
Average Age of Trailers
Trucks - Average Annual Miles
Trucks - Replacement Policy Years
Trucks - Depreciation Policy Years
Trucks - Depreciation Policy Residual %
Trailers - Average Annual Miles
Trailers - Replacement Policy Years
Trailers - Depreciation Policy Years
Trailers - Depreciation Policy Residual %
Current Aggregate Monthly Loan/Lease Payments
Current Aggregate Monthly Operating Lease Payments
Will payments to the funding bank originate from Non-U.S. locations?*
- No
- Yes
If yes, list the countries from which the payments will originate:
Will the Equipment be used outside of the United States?*
- No
- Yes
If any of the company’s trailers will operate in Mexico, please complete the “BSA Questionnaire – Trailers in Mexico” form.
By submitting this application:
I certify that the information stated in this application is true and correct. I understand that you will retain this application whether or not it is approved. You and/or entities to whom you refer this application are authorized to check my credit and employment history, obtain insurance information and to answer questions about your credit experience with me. I authorize you and/or entities to whom you refer this application to contact my creditors and authorize any creditor so contacted to release to you such credit information as you may request. I further authorize you and/or entities to whom you refer this application to share this application and my information, including credit bureau reports and credit references, with potential purchasers or assignees of transactions that result from this application. Notice: To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify and record information that identifies each person (individuals or businesses) who opens an account. What this means for you: When you open an account or add any additional service, we will ask you for your name, address, and taxpayer identification number that will allow us to identify you. We may also ask to see other identifying documents. Your signature may be required at final approval.
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Finance Application - 2015

Legal Owner/Guarantor Information

Section Break

Section Break

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Related Companies

Top Three Customers

Banking Reference

Fleet Statistics

If any of the company’s trailers will operate in Mexico, please complete the “BSA Questionnaire – Trailers in Mexico” form.

By submitting this application:

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