AEC PRE-QUALIFICATION FORM

PRE-QUALIFICATION FORM
Business Information
Legal name of business *
DBA (doing business as)
Type of business entity*
State of formation*

Street Address

Street Address Line 2

City

Zip Code
Industry type*
Street address of business*
Suite, Room
City*
State*

Street Address

Street Address Line 2

City

Zip Code
Zip*
Business phone*
Please enter a valid phone number.Format: (000) 000-0000.
Business tax ID (9 digits) *
Business start date*

MonthDayYear
Your business website
How much financing do you need?*
Avg. monthly revenue*
Type of Transaction*
Last year revenue*

Personal Information Owner(s)
- First name*
- Last name*
- Email address*
  example@example.com
- Home phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Date of birth*
  
  MonthDayYear
- Your SS Number*
  (required to verify your identity)
- Home address*
- City*
- State*
  
  Street Address
  
  Street Address Line 2
  
  City
  
  Zip Code
- Zip*
- Your ownership percentage*
- Your credit score*
- YesNo
- First name*
- Last name*
- Email address*
  example@example.com
- Home phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Date of birth*
  
  MonthDayYear
- Your SS Number*
  (required to verify your identity)
- Home address*
- City*
- State*
  
  Street Address
  
  Street Address Line 2
  
  City
  
  Zip Code
- Zip*
- Your ownership percentage*
- Your credit score*
- Please describe how this financing will result in added benefit to your business.
- By signing this Application, whether as a principal of the applicant or as a personal guarantor, I/we declare under penalty of perjury that all information contained in this Application and any financial information provided is true, correct, and complete as of the date submitted to Alliance Equipment Capital LLC. I/We understand that Alliance Equipment Capital LLC is relying on this Application and the information herein to extend, modify, or renew credit or financing. I agree to immediately notify Alliance Equipment Capital LLC of any material change or deterioration in the information provided. I/we authorize Alliance Equipment Capital LLC (and any assignee) to verify any information from any source it deems appropriate, including obtaining and reviewing my/our personal credit profile from a national credit bureau for the purpose of evaluating this Application, as well as for any renewal, extension, or collection of the resulting account. A copy or facsimile of this Agreement with my/our signature shall be considered an original.
- Owner 1 Signature*
- Date*
  
  MonthDayYear
  Date
- Owner 2 Signature*
- Date*
  
  MonthDayYear
  Date
Should be Empty:

PRE-QUALIFICATION FORM

Business Information

Personal Information Owner(s)