Fortis Vision Solutions Credit Application Form

Credit Application

Business Information
Business Name*

DBA
EIN
Employer Identification Number
Business Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address*
example@example.com
Type of Business*
Ex: LLC, Corp, Association, Partnership
Website
Business Start Date*

MonthDayYear
Date
State of Incorporation*
This field is required
Monthly Gross Revenue*
Estimate is fine
Industry*
This field is required
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant and Equipment Information
- EquipmentWorking Capital
- Requested Loan Amount*
- Equipment Description*
  Equipment type, make, model
- Seller Name
  Dealer or Seller name
- Full Legal Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Business Title*
- Percent of Ownership*
  e.g., 100%
- Date of Birth*
  
  MonthDayYear
  Date
- SSN*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Estimated Credit Score*
- Homeowner
- Years of Industry Experience*

Document Upload

Please upload any documents you can at this time.

Our underwriting team will contact you via email once you submit your application.
Three Months of Bank Statements

Cancelof
Drivers License

Cancelof
Invoice for Equipment

Cancelof
Other

Cancelof

Review and Sign
Signature*
Date*

MonthDayYear
Todays Date
Hour MinutesAM/PM Option
Should be Empty: