Credit Application (ODP)

ADG CREDIT APPLICATION
Questions? Call Bill Waddell 888-461-7002

Bwaddell@NavitasCredit.com
LESSEE INFORMATION
Legally Registered Name
Trade/DBA Name
Primary Contact
Physical Address (HQ or Existing Street Address) City, State, Zip Code
Phone Number
Please enter a valid phone number.
Ext.
Equipment Location (New, If Moving or Expanding) City, State, Zip Code
Primary Contact Cell Phone
State of Incorporation
Type of Business

ProprietorshipPartnershipC-CorporationS-CorporationLLCNon Profit
Years in Business
(Minimum of 2 Years Under Current Owner, Or Call For New Business Program Quote)
Years
Months
# of Employees
Do You Own the Equipment Location?

YesNo
Nature of Business
E-mail Address
example@example.com
Federal ID #
BUSINESS CHECKING INFORMATION
Name of Bank
Phone Number
Please enter a valid phone number.
Contact
Average Balance
PRINCIPAL INFORMATION

NON PROFITS, PUBLIC COMPANIES & MUNICIPALITIES MAY LEAVE BLANK
Name

Principal First NameLast Name
Home Address (Street Address, City, State, Zip)
Title
% Ownership
Home Phone #
Cell Phone #
Social Security Number
Name

Principal First NameLast Name
Home Address (Street Address, City, State, Zip)
Title
% Ownership
Home Phone #
Cell Phone #
Social Security Number
EQUIPMENT INFORMATION

Please fill out known information
Equipment Investment
Estimated Description
Please "X" All That Apply:

NewRemanufacturedUsed
Are you purchasing additional equipment for your office you would like to lease, such as phones, computers, furniture, security...?

YesNo
Lease Term

24 months36 months48 months60 months
Expected Delivery Date

MonthDayYear
Date
Purchase Option
By signing below, the undersigned individual as principal of and/or guarantor for the applicant, authorizes ADG Capital, its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of the update, renewal, or extension of credit to the applicant or the collection of any resultant accounts. A fax or photocopy of this authorization shall be valid as the original.

*ALL PRINCIPLES LISTED ABOVE MUST SIGN THIS APPLICATION.
Signature

Clear
Date

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

ADG CREDIT APPLICATION

LESSEE INFORMATION

BUSINESS CHECKING INFORMATION

PRINCIPAL INFORMATION

EQUIPMENT INFORMATION