Equipment Financing Request Form

Equipment Financing Request Form
Name

First NameLast Name
Are you a startup?

YesNo
Email
example@example.com
Phone Number
Please enter a valid phone number.
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your credit?

Poor (300-600)Fair (601-660)Good (661-780)Excellent (781-850)
Social Security Number
Business Type

Limited Liability CompanyCorporationSole ProprietorshipPartnershipOther
How many owners are there and what is the ownership breakdown? Type answer
What are your annual gross sales? Type answer
What type of equipment are you looking to purchase? Type answer
Are you purchasing from a vendor or a private party? Type answer
What is your budget for monthly payments? Type answer
Can you put a down payment and if so, how much? Type answer
How much do you plan to make per month with the new equipment? (ROI) Type answer
Funding you require

Less than $200K$200K - $400K$400 - $1MMore than $1M
How soon do you need the financing approval?

Less than 15 days15 days - 1 month1 -3 months3-6 months6 months - 1 year
Have you applied with another lender yet?

YesNo
Who referred you to Hampton Equipment Capital? Type a label
Date

MonthDayYear
Date
Signature

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By submitting this application, you are granting Hampton Equipment Capital permission to pull your credit report if necessary for us to help qualify you.

A Hampton Equipment Capital representative will reach out shortly as information is needed.
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