Credit Application

Credit Application
Business Information
Business Name
DBA
EIN Number
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Business Email
johnny.appleseed@outlook.com
Type of Business
Website
if applicable
Business Start Date

MonthDayYear
Date
State of Incorporation
Industry
Monthly Gross Revenue
estimate is fine
Business Address

Street Address

Street Address Line 2

CityState

Zip Code

Request Information

Equipment Loan or Working Capital
Loan Type
Requested Loan Amount
Equipment Description
Equipment type, make, model
Seller Name
Dealer or Seller name
Personal Information
Name

First NameLast Name
Title
Business Title
Percent Ownership
Date of Birth

MonthDayYear
Date
SSN #
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Estimated Credit Score
Homeowner
Years of Industry Experience
Citizenship
Personal Address same as Business?
Personal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Document Upload
Please attach the following documents if accessible:
- Invoice, Quote, or Bill of Sale for Equipment
- 3 months of most recent business bank statements
- Copy of Drivers License
^{* A representative from our operations team will reach out to shortly after submission. Any documents not attached to the application can be supplied via email at a later time *}
Cancelof

Review and Sign
Terms and Conditions
Signature
Date

MonthDayYear
Date
Should be Empty: