Star-A-Liner Lease Application
General Information
Choose One:	Proprietor Partner Corporation
Legal Name of Firm:
Doing Business As:
Address:
City:
County:	State: Zip:
Telephone Number:
Years in Business:
Type of Business:
Fed ID#
President's / Owner's Information:
President / Owner's Name:
Title:
Home Telephone:
Home Address:
City:	State:  Zip:
Social Security #:

Trade References:
Trade # 1:		Contact:		Phone#:
Trade # 2:		Contact:		Phone#:
Trade # 3:		Contact:		Phone#:

Do you have Insurance on your shop?	Yes No
Bank Information Release:
Bank Name:
Attention:
Address:
City:	State:  Zip:
Acct #:	Checking: Savings:
Phone #:	Fax:
AGREEMENT
I hereby verify that all information provided is true and correct. Also I hereby authorize our banks, trade references, and financial institutions the right to release credit information.
Name	I agree  I disagree
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