TERMS DESIRED |
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INSURANCE COMPANY/PHONE |
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PRIMARY USAGE |
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FLYING EXPERIENCE |
PILOT |
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AGE |
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TYPE LICENSE |
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IFR RATING |
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FLIGHT HOURS |
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EAA Member* |
If yes, please provide your member number:
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*Please note that your EAA membership number will be provided to EAA to inform them that you have taken advantage of this financing opportunity to receive preferred rates and terms as an EAA member.
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BUSINESS INFORMATION (if applicable) |
NAME OF CORP PARTNERSHIP |
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ADDRESS |
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CITY |
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STATE |
ZIP
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FISCAL YEAR END |
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TYPE OF BUSINESS |
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STATE & DATE OF INCORPORATION |
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NO. OF EMPLOYEES |
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FEDERAL TAX I.D. NO. (EIN) |
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PRODUCT OR SERVICE PERFORMED |
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PRINCIPALS |
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% OF OWNERSHIP |
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TITLE |
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BUSINESS FINANCIAL OBLIGATIONS AND/OR CREDIT REFERENCES |
NAME, CITY, STATE (1) |
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AMOUNT OF LOAN (1) |
$
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BALANCE (1) |
$
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NAME, CITY, STATE (2) |
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AMOUNT OF LOAN (2) |
$
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BALANCE (2) |
$
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NAME, CITY, STATE (3) |
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AMOUNT OF LOAN (3) |
$
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BALANCE (3) |
$
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PERSONAL FINANCIAL STATEMENT |
The following is submitted for the purpose of procuring, establishing and maintaining credit with YOU in behalf of the undersigned persons, firms or corporations in whose behalf the undersigned may either severally or jointly with others execute a guaranty in your favor. The undersigned warrants that this financial statement is true and correct and that you may consider this statement as continuing to be true and correct until a written notice of a change is given to you by the undersigned. |
PLEASE DO NOT LEAVE ANY QUESTIONS UNANSWERED. USE 'NO' OR 'NONE' WHERE NECESSARY. IF ADDITIONAL SCHEDULES ARE USED, PLEASE SIGN, DATE AND ATTACH THEM TO THIS FORM. PLEASE INDICATE WHETHER ASSETS OR LIABILITIES ARE INDIVIDUAL JOINT WITH SOMEONE ELSE. |
ASSETS |
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LIABILITIES |
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Complete the following information about both the Applicant and Joint Applicant or Other person (if Applicable): |
Are you obligated to make alimony, Support or Maintenance Payments?
If yes, to (Name & Address)
Amt. per Month $
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Are you co-maker, endorser or Guarantor on any loan or contract?
If yes, to whom owed?
Amt. per Month $
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Are there any unsatisfied judgments against you?
If yes, to whom owed?
Amt. per Month $
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Have you been declared bankrupt in the last 10 years?
If yes, when?
Year?
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Are you interested in learning about Aircraft Insurance Products? |
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YES, I am interested in the opportunity to receive a quote from Gulf Coast Underwriters for insurance coverage. I permit you to share my contact information with Gulf Coast Underwriters for purposes of receiving a quote on the insurance products they offer. Gulf Coast Underwriters is a non-affiliated company of NAFCO and will not share any information with Gulf Coast Underwriters without your permission. You are under no obligation to purchase insurance from Gulf Coast Underwriters.
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Applicant(s) certifies that all information contained in this application or in any other document submitted for the purpose of obtaining credit is true, complete and correct and accurately reflects Applicant(s)' current financial condition. In order to provide the Applicant with National Aircraft Finance Company products and services, applicant(s) authorize National Aircraft Finance Company, its affiliates, or its authorized agents to verify any and all information to make any inquires of others, including but not limited to, procuring reports from consumer reporting agencies, credit bureaus, and the Internal Revenue Service, and to provide information arising out of Applicant(s) transaction or experience with it or others. Any reference, employer or creditor named herein is expressly authorized to furnish National Aircraft Finance Company with information in connection with this application. This application shall remain the property of National Aircraft Finance Company and may require Applicant to provide updated financial information on an annual basis. |
APPLICANT |
DATE
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CO-APPLICANT |
DATE
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