Online Application | Key Commercial Corp.

Legal Company Name*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Years in Business*

Company Phone*

Cell Phone

Contact Person*

Contact Phone*

Contact's Email*

Type of Business(1)*

Equipment Location (if different)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Business Structure*

Proprietorship

Partnership

Corporation LLC

Fax

Federal ID #(1)*

Website

EQUIPMENT INFORMATION

Bank Name 1

Name(1)

First

Last

Equipment

Cost

Approximate age of equipment:

PRINCIPAL INFORMATION

Name*

First

Last

Title*

% Owned*

Phone*

Home Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Social Security #*

Name(2)

First

Last

Title (2)

% Owned (2)

Phone (2)

Home Address(1)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Social Security # (2)

BANK REFERENCES –Depository, Commercial Loans, and Lines of Credit

Bank Name 1

Branch Location

Officer

Bank Phone #

Account #

Type of Account

Bank Name (2)

Branch Location (2)

Officer (2)

Bank Phone # (2)

Account # (2)

Type of Account (2)

TRADE REFERENCES

Name of Supplier 1*

Name of Supplier 2*

Insurance Name*

Landlord Name*

Supplier 1 Phone*

Supplier 2 Phone*

Insurance Phone*

Landlord Phone*

Supplier 1 Contact Name*

Supplier 2 Contact Name*

Insurance Contact Name*

Landlord Contact Name*

SIGNATURES

By Signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of it obligations, provides written instruction to Key CommercialCorp. or it designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extendto obtaining bank & trade information for considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and forreviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. I understand that by providing our company’s phone/faxnumbers, I consent to receive all phone/fax communications sent by or on behalf of Key Commercial Corp. By signature below, I/we affirm my/our identity as the respective individual/s identified in the above application.

Please Type Name as Your Signature*

First

Last

Your Title*

Date*