Online Finance Application
Company Information
Company Name
*
DBA
Start Date
-
Month
-
Day
Year
Date
Tax ID
Phone Number
Please enter a valid phone number.
Company Website
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the equipment location the same as the business address?
Yes
No
Equipment Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Description
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Contact Information
By adding the following requested information, the undersigned individual(s), who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application.
Primary Contact
*
First Name
Last Name
Ownership %
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
SSN
*
Birthday
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add an additional Guarantor?
Yes
No
Additional Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Ownership %
Email
*
example@example.com
SSN
*
Birthday
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add an additional Guarantor?
Yes
No
Additional Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Ownership %
Email
*
example@example.com
SSN
*
Birthday
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Finance Amount
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age ((provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Lessor set forth above within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.
Type of Financing
Equipment
Working Capital
Financing Amount ($)
Equipment Vendor
Equipment Description if Applicable
Equipment Use/Purpose
File Upload - Bank Statements and/or Quotes
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I authorize all deposit, borrowing, and trade information to be released to the Lessor. I hereby represent all information is true, correct and complete. A photo static or facsimile copy of this authorization shall be valid as the original.
*
Yes
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