BUSINESS INFORMATION (1 of 4)

BUSINESS INFORMATION (1 of 4)
Company Legal Name/Lessee:*
DBA:
Company Address:*
City:*
State:*
County:*
Zip Code*
First Name:*
Last Name:*
Contact Title:
Phone:*
E-mail:*
Federal Tax ID #:
Business Start Date:*

MonthDayYear
Equipment Usage Location:*
Business Structure:*

ProprietorshipCorporationLLCPartnershipNon-Profit
Tax Exempt:

YesNo
Equipment Cost:*
Equipment to be Leased/Financed:*

OWNERSHIP INFORMATION (2 of 4)
How many owners on the application?
Owner #1 Information
First Name:
Last Name:
Title:
% Ownership:
SSN:
Date of Birth:
Home Address:
City:
State:
Zip Code:
Phone Number:
Owner #2 Information
First Name:
Last Name:
Title:
% Ownership:
SSN:
Date of Birth:
Home Address:
City:
State:
Zip Code:
Phone Number:
Owner #3 Information
First Name:
Last Name:
Title:
% Ownership:
SSN:
Date of Birth:
Home Address:
City:
State:
Zip Code:
Phone Number:
Owner #4 Information
First Name:
Last Name:
Title:
% Ownership:
SSN:
Date of Birth:
Home Address:
City:
State:
Zip Code:
Phone Number:

NOTES (3 of 4)

Please include any other information you would like considered as part of the application

AUTHORIZATION FOR CREDIT INQUIRY (4 of 4)
The undersigned (individually and collectively “Guarantor”) whose signature(s) appear below personally and individually represent and warrant to American Capital Financial Services, Inc. ("ACFS”) that required if equipment is leased/financed to the Business and Guarantor agrees to provide such guarantee(s) if so required. Guarantor authorizes ACFS, its agents, assigns and the financial institutions, funding sources, credit bureaus used by ACFS and any other person or entities working with ACFS to attempt to facilitate the leasing/financing of equipment to the Business (all such individuals and entities hereinafter collectively referred to as “American Capital Affiliates”) to investigate on an ongoing basis, obtain and share financial and related information from any source about Guarantor’s personal credit standing and credit worthiness, including obtaining “consumer reports” as defined in the Fair Credit Reporting Act (“FCRA”) for the purpose of evaluating Guarantor’s personal credit worthiness to guarantee the Business’s obligations under any actual or proposed equipment lease/finance or extension or renewal thereof. By his or her signature, Guarantor, personally and individually, authorizes ACFS and their Affiliates to share Guarantor’s personal consumer reports and other personal information and hereby directs any credit bureau or similar agency holding credit information, including “consumer reports” as defined in the FCRA, concerning Guarantor to provide such information to ACFS and their Affiliates for purposes indicated herein. Guarantor irrevocably waives any and all rights, claims and causes of action Guarantor might have under the FCRA against ACFS and its Affiliates for use of consumer reports or other materials for the purposes indicated herein. Guarantor represents and warrants that any equipment sought to be leased/financed through ACFS will be exclusively for the Business’s business use and not for personal, family or household purposes.

By signature below, I/we affirm our identity as the respective individuals identified in the related application.
Name:*

First NameLast Name
Title:*
Date:*
Signature:*

Clear
Should be Empty:

BUSINESS INFORMATION (1 of 4)

OWNERSHIP INFORMATION (2 of 4)

NOTES (3 of 4)

AUTHORIZATION FOR CREDIT INQUIRY (4 of 4)