Name of Firm: Telephone # Address: Mailing Address (if different from above) Previous Address: How long Nature of Business: in business? Is company a: Partnership Rhode Island Based Proprietorship all that apply) If a Rhode Island Based, when incorporated Contractor License #: (If applicable) Other DBA’s: List Officers, Partners, or Owners Position or % Owner Name Home Address S.S.# Banking Information Acct. Bank Name: Installment Loan Number: Commercial Loan Address: Balance: Acct. Bank Name: Installment Loan Number: Commercial Loan Address: Balance: Acct. Bank Name: Number:
Name of Firm: Telephone # Address: Mailing Address (if different from above) Previous Address: Nature of Business: How long in business? Is company a: all that apply) Rhode Island Based Proprietorship Partnership If a Rhode Island Based, when incorporated Contractor License #: (If applicable) Other DBA’s: List Officers, Partners, or Owners Position or % Owner Name Home Address S.S.# Banking Information Bank Name: Acct. Number: Installment Loan Commercial Loan Address: Balance: Bank Name: Acct. Number: Installment Loan Commercial Loan Address: Balance: Bank Name: Acct. Number:
2018_Section_10-Statistical_Data.docx