Credit Application

Company Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Federal ID/TIN Number*

Time in Business*

Number of Owners*

Equipment Cost*

Supplier or Vendor

Equipment or Software Description

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

SSN*

Percent Ownership*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

example@example.com

SSN*

Percent Ownership*

Agreement

By submitting this form, applicant hereby authorizes the release of credit information to our company, or its designee (and any assignee or potential assignee thereof) from any source including credit bureau reporting agencies and applicant’s bank. If personal information is provided, by clicking below, the above named individual(s) provides written instruction to Univest Capital, Inc., or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. I hereby represent that all the information contained in this credit application is true, correct, and complete. This application is made under and shall be governed by the laws of the State of Pennsylvania. All loan applications are subject to approval. Interest rates vary based on credit score and other credit criteria. Univest Capital, Inc. is a subsidiary of Univest Bank and Trust Co. Equal Opportunity Lender.

Please Call for an Application - 1.866.604.8160

Credit Application

Owner 1

Owner 2