Click to Print This Page Credit Application

You may print this form (using the Print command of your browser) and mail or fax it to Fasig-Tipton as specified below.

Please complete entire form and Mail to:

Fasig-Tipton Company, Inc.
2400 Newtown Pike
Lexington, KY 40511
Phone: (859) 255-1555
Fax: (859) 254-0794 (Type or print)

SALE: _________________________________________DATE:_____________________________
AMOUNT OF CREDIT REQUESTED ____________________________________________________
PURCHASES WILL BE IN THE NAME OF _______________________________________________
PERSON RESPONSIBLE FOR ACCOUNT _______________________________________________
ADDRESS _________________________________________________________________________
CITY ________________________STATE _______________________ZIP______________________
SOCIAL SECURITY NUMBER ___________________________________
BIRTHDATE__________________________________________________
TELEPHONE: HOME _________________BUS_____________________
FAX NUMBER ________________________________________________

ACCOUNT/CREDIT INFORMATION TO BE OBTAINED
BY APPLICANT FROM FINANCIAL INSTITUTION

IN ORDER FOR FASIG-TIPTON COMPANY TO PROCESS THIS CREDIT APPLICATION, CERTAIN ACCOUNT AND CREDIT INFORMATION FROM YOUR FINANCIAL INSTITUTION-BANK, CREDIT UNION, OR BROKER MUST BE DOCUMENTED ON THE INSTITUTION'S LETTERHEAD AND SIGNED BY YOUR ACCOUNT OFFICER. INFORMATION REQUIRED INCLUDES TYPE OF ACCOUNT, AVERAGE BALANCE DURING THE PAST TWO YEARS, OFFICER'S NAME AND TITLE, NAME AND ADDRESS OF THE INSTITUTION, ACCOUNT NUMBERS OF ALL RELEVANT ACCOUNTS AND THE INSTITUTION'S TELEPHONE NUMBER. EXISTENCE OF AVAILABLE LINES OF CREDIT AND LOAN PERFORMANCE ARE SPECIFICALLY TO BE INCLUDED.

BY SIGNING THIS FORM, APPLICANT AUTHORIZES FASIG-TIPTON COMPANY TO PERFORM A CREDIT INVESTIGATION. PLEASE NOTIFY YOUR FINANCIAL INSTITUTION THAT FASIG-TIPTON COMPANY WILL BE CONTACTING THEM ABOUT YOUR REQUEST FOR CREDIT.

Signature: __________________________________________________________