Finance Application

Finance Application
Name of Applicant*

First NameLast Name
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Please enter a valid phone number.
Business Tax ID*
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Social Security #*
Bank Name*
Bank Phone Number*
Please enter a valid phone number.
Bank Contact*

First NameLast Name
Current Balance*
Business Ownership
Business Structure*

LLCDPACorporationPartnershipOther
Date of Incorporation*

MonthDayYear
Date
Any Legal Action Filed Against Business and/or Principals?*
Sales Tax - Exempt #
Principals (Must list all principals – 100% of Ownership)*
Principal Name*

First NameLast Name
% of Ownership*
DOB

MonthDayYear
Date
Principal Phone*
Please enter a valid phone number.
Principal Email Address*
Principal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal Name(If more than one)

First NameLast Name
% of Ownership
DOB

MonthDayYear
Date
Principal Phone Number
Please enter a valid phone number.
Principal Email Address
Principal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal Social Security Number (If more than one)
Briefly Describe Operation (Trucking, farming, hauling etc.)
Equipment Overview
Type of Equipment*
Equipment Make, Model, Year*
ID Number
Purpose of Equipment(Expansion, Replacement)*
Will this equipment help generate revenue for the business?*
Equipment Vendor*
Vendor Contact Name*

First NameLast Name
Vendor Phone Number*
Please enter a valid phone number.
Purchase Price*
Amount of money for down payment/security deposit?*
Payment Frequency*

MonthlyQuarterlySemi AnnuallyAnnually
Do you have a detailed product description and quote from a dealer/vendor? *
If so upload it here

Cancelof
I/we hereby authorize you to whom this application is made, or your agents, to investigate my/our credit worthiness and will provide financial statements, tax returns, etc. as you deem necessary. I/we agree that the advanced amount is not refundable unless the application is rejected by the Lessor. By the execution of the lease agreement, I/we warrant that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information. Further, I/we warrant it is understood that the Lessor reserves the right to reverse any credit decision if the information contained herein is found to be incorrect. By signing below, the undersigned individual as principal of and/or guarantor for the applicant, authorizes Legacy Capital Group, it’s 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. I consent to receiving faxes/emails from Legacy Capital Group.
Date*

MonthDayYear
Date
Signature*

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Finance Application

Business Ownership

Equipment Overview