Company Information
Business Name
Address
City
State
Zip
Phone
Fax
Officer 1 Name
Title
SS #
Ownership %
Ownership %
Officer 2 Name
Title
SS #
Bank Reference
Bank Name
Account #
Contact Person
Phone
Borrowing Reference
Lender Name
Phone
Account #
Fax
Tax returns & financial info NOT required
Required for requests over $75,000
Equipment | Vehicles | Furniture | Software
Estimated Cost
$
Description
Seller Name
Desired Term (in months)
Officer 1
Signature
Date
Officer 2
Signature
Date
Seller Phone
new
24
36
48
60
-or-
-or-
-or-
Purchase Option
$1
10%
FMV
-or-
-or-
used
Signature below authorizes verification of credit information from whatever source deemed appropriate. Such authorization
extends to obtaining business references as well as any/all individual credit report profiles from any national credit reporting
agency, as well as authorizes banks, trade/borrowing references and financial institutions to release all credit information
requested, and furthermore waives any potential right or claim they may have under the Fair Credit Reporting Act. A copy of this
Credit Release Authorization is deemed to be the equivalent of the original.
Equipment Financing
Application
FAX
toll- ee (8
88) 391-6
728
Phone
toll- ee (8
00) 245-1
213