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TEAM Funding Solutions
BROKER ENROLLMENT FORM
TURN YOUR “C” CREDITS INTO APPROVALS

“We Approve C-Credit Leases for the Broker Community”

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Company Information

Company Name/DBA *

Company Type Corporation Partnership Proprietorship

Date Established (Mo)  (Year) /

Address

# of Employees

# Sales People

City

State

Zip

Niches

Vendor Driven Lessee Driven

Phone *

Fax

Email *

State Incorporated

Federal Tax ID #

Web Site URL

Owner/Shareholder Information

First Name

Initial

Last Name

Title

Address

City

State

Zip

First Name

Initial

Last Name

Title

Address

City

State

Zip

Association Reference

		Association Name				Date Joined
		Association Name				Date Joined

Funder References

Company Name

Phone Number

Fax Number

Date Open

Contact

Average Ticket

Company Name

Phone Number

Fax Number

Date Open

Contact

Average Ticket

		Forecasted monthly C-credit lease applications				Average Ticket
		Contact Name				Title
		Contact Phone Number