EquipCash Application

Financing Questionnaire

• 100% Encrypted • Soft Credit Pull
Company Details
Company Legal Name
DBA
if available
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name

First NameLast Name
Contact Phone Number
Format: (000) 000-0000.
Contact Email
example@example.com
Company Type
Industry Type
Business Start Date

MonthDayYear
Date
Last Year's Gross Income
This Year's Gross Income
Anticipated with equipment
Federal Tax ID (EIN)
OPTIONAL: "As Needed"

Documents Securely uploaded
Cancelof
Number of owners (20% or more shares)
All owners of 20% or more must fill out the owner's form at: www.equipcash.com/additional-owner-equipment-financing-application

Please contact them and let them know to complete the link.
Do you approve sending the additional owner's form link to the additional owner(s)?
Email address(es) of additional owners
example@example.com

Owner Information

20% or More
Name

First NameLast Name
Middle name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Title
Percentage of Ownership
Date of Birth

MonthDayYear
Date
Social Security Number
100% Encrypted
Signature Page

Owner
Agreement and Terms

INDIVIDUAL AUTHORIZATION: By signing below, I/we authorize the holder of this form and its agents, successors, and assigns ("Authorized Party") to obtain consumer credit reports, business credit reports, and any other information deemed necessary to evaluate this financial statement in connection with a credit, lease, or financing application. I/we certify that the information provided is true, accurate, and complete to the best of my/our knowledge. I/we understand that any misrepresentation may result in denial of credit or legal consequences. I/we agree to notify the Authorized Party of any material changes in financial condition.
Signature

Owner Information 2

20% or More (if available)
Name

First NameLast Name
Middle name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Title
Percentage of Ownership
Date of Birth

MonthDayYear
Date
Social Security Number *100% Encrypted
if available
Owner Information 3

20% or More (if available)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Title
Percentage of Ownership
Owner Information 4

20% or More (if available)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Title
Percentage of Ownership
Owner Information 5

20% or More (if available)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Title
Percentage of Ownership
Signature Page

Owner (if available)
Agreement and Terms

INDIVIDUAL AUTHORIZATION: By signing below, the undersigned individual who is either a principal of the credit applicant or a personal guarantor of its obligations, provides EquipCash and its assigns written authorization to obtain and review his/her personal consumer report from any reporting agency in connection with this application, whether or not his or her credit is being relied upon in connection with this application. If you request, EquipCash will provide you with the name and address of the person to whom the request for any consumer report was made. You are entitled to receive certain information from that reporting agency upon request.
Signature

Equipment Information

Desired Equipment or Currently in Use
Equipment
Type of Equipment
Transaction Type
Transaction Type
Vendor Name
if available
Vendor Website
Equipment Cost
(approximate)
Additional Information
If Needed
Invoices or Brochure

If available
Cancelof
Check Box if Human
Should be Empty:

Financing Questionnaire

Company Details

Owner Information

Signature Page

Owner Information 2

Owner Information 3

Owner Information 4

Owner Information 5

Signature Page

Equipment Information