Main Office:
Correspond to:
1799 W. Oakland Park Blvd.
Capital TempFunds
Third Floor
1799 W. Oakland Park Blvd.
Ft. Lauderdale, Florida 33311
Ft. Lauderdale, Florida 33311
(800) 562-3863 / (954) 660-7511
(800) 562-3863 / (954) 660-7511
Fax: (954) 414-6611
Fax (954) 414-6611
Application
Company Legal Name:
Trade Name(s), if any:
Is it Registered?
Executive Office Address (no PO Box):
Suite # (if applicable):
City:
County:
State:
Zip:
Telephone:
Cell #:
Fax:
Federal Tax Number:
Date Incorporated:
Date Founded:
State of Incorporation:
E-mail address:
Web address:
Status:
“Sub S” –Corporation
Non-Profit
Limited Liability Company
Proprietorship
“C” –Corporation
Partnership
Limited Liability Partnership
Accountant
Insurance Agent
(Name, Address and Telephone Number):
(Name, Address and Telephone Number):
___________________________________________ _____________________________________________
___________________________________________
1. Does the company have any active or satisfied liens, including tax liens or liens from lenders, against any of its assets
(exclude leased equipment)?
Yes
No If yes, explain:
2. Does the company, or its owners, officers, directors or guarantors have, or have had in the past, any litigation,
bankruptcies, judgments, credit problems, criminal charges or convictions, or regulatory actions against them?
Yes
No
If yes, explain: