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Credit Application
Equipment Financing
Complete this credit application for lease-to-own equipment financing. Please provide accurate business and owner information so we can review your request
BROKER NAME
First Name
Last Name
Broker Tel
Please enter a valid phone number.
Format: 5149990127.
Email
Vendor ID
Vendor Name
Rep
Rep Email
example@example.com
Submission Source
Legal Name of the Business
*
Operating Name of the Business
*
Area of Activity/Industry
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Telephone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Years In business
*
Please Select
0-1 years
1-5 years
5-10 years
10 years+
Business Email
*
example@example.com
Legal actions against company?
*
Yes
No
Commercial Bankruptcy in Past
*
Yes
No
Use for Equipment
*
Add
Replacement
Refinance
Equipment Type
Equipment Cost
*
Equipment Quote/Invoice
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional Notes?
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Shareholder 1/Partner 1
Contact Name
*
Contact Personal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Residence
*
Owner
Renter
Home Value
*
Mortgage Balance (if applicable)
*
Social Insurance Number
*
Date Of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Have you ever filed for personal bankruptcy?
*
Yes
No
If yes, date of release?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Is there a second partner
*
yes
no
Contact 2 Name
First Name
Last Name
Contact 2 Personal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Residence
Owner
Renter
Home Value
Mortgage Balance
Social Insurance Number
Date Of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Have you ever filed for personal bankruptcy?
yes
no
Date of Release?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Authorization
The undersigned attests that information above is true and complete by signing below. I confirm/we confirm that Affiliated Financial Services Inc. and its affiliates and (or) third party providers and (or) any financial institution chosen (collectively referred to as "AFS") can collect, use and rely on such commercial and/or personal information to confirm my identity, evaluate my credit worthiness and the risks in relation to the financing being requested and to comply with its legal and regulatory obligations. The undersigned allow AFS to get from any credit agency or lending company commercial information and/or personal information which could be required with respect to this credit application, including a credit bureau. I/we confirm also that AFS may disclose commercial and/or personal information related to the undersigned to any credit agency or lending company with which it maintains financial relationship. The undersigned recognises that AFS will keep a file containing some or all of my personal information, whether or not the requested credit is granted. The undersigned understands that he has a general right to access and rectify the personal information in this file by making a written request to AFS.
Signature Partner 1
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is a second signature required
*
yes
no
Signature Partner 2
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: