Hempire - Equipment Application

Business Information
Company Name*
Company Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Company Email*
example@example.com
Social Security Number*
TAX ID/EIN Number:*
Entity Type
Company Phone Number
Preferred Method of Contact*
Personal Information
Applicant Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Phone Number*
Percentage of Ownership:
Date of Birth:
Co-Applicant Information (if applicable)
Co-Applicant Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:
Social Security Number
Co-Applicant Email Address
example@example.com
Co-Applicant Phone Number
Please enter a valid phone number.
Percentage of Ownership:
Loan Details
Loan Amount Requested ($)*
Term Length (months)*
Terms range from 12-84 months (based on approval/credit)
Maximum Down Payment*
*10% is standard(dependent on credit and overall health of the business, can be up to 40-50% for challenged credit.*
Equipment Description/Seller Name*
Provide Seller/Vendor Name and a brief description of the equipment you are looking to finance
Upload Documents Here:

Please attach your last 4 months of Business Bank Statements in a PDF. ALL pages are required for submission.
Cancelof
Applicant Signature (Required)*

Clear
Co-Applicant Signature (Optional)

Clear
Agreements:

Additional information may be required based upon time in business, current credit standing, and
application amount. Each individual signing below certifies that the information provided in this
credit application is accurate and complete. Each individual signing below authorizes you or any
lender or funding source which may be utilized (collectively referred to as “Lenders”) to obtain
information from the references listed above and obtain a consumer credit report that will be
ongoing and relate not only to the evaluation and/or extension of the business credit requested,
but also for purposes of reviewing the account, increasing the credit line on the account (if
applicable), taking collection action on the account, and for any other legitimate purpose
associated with the account as may be needed from time to time. Each individual signing below
further waives any right or claim which such individual would otherwise have under the Fair Credit
Reporting Act in the absence of this continuing consent.
Agree
Should be Empty:

Business Information

Personal Information

Co-Applicant Information (if applicable)

Loan Details