Standard Credit Application

Equipment Info (One Piece of Equipment Per Row)

Equipment Cost ($)	Description	Vendor Name

Information on Owner(s), Guarantor(s)

We will obtain a consumer credit report about each person identified as a guarantor in this application. The user providing us with guarantor information represents that (a) each guarantor has authorized the user to supply us with such information in this application and (b) each guarantor understands that we will obtain a consumer credit report about the guarantor in connection with this application.

Name*

First MI Last

Marital Status*

% Of Business Owned*

Title*

Social Security Number*

Date of Birth*

Home Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Are you the 100% owner or guarantor?*

Bank Information

Name of Bank*

Bank Address*

Street Address Address Line 2 City State ZIP Code

ABA Routing #*

Bank Account #*

Bank Phone Number*

Bank Contact Name*

Loan History

Lending Institute*

Address*

Street Address Address Line 2 City State ZIP Code

Account #*

Finance Amount ($)*

Contact Phone*

Contact Fax*

Contact Name*

Contact Email Address*

Do you need to add additional loan information?*

Lending Institute*

By digitally signing this document, the undersigned individual, who is either a principal or a personal guarantor of its obligations, authorizes lessor and/or debtor and their affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or creditworthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal, or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat/facsimile/digital copy of this authorization shall be valid as the original. By signature below, I affirm my identity as the respective individual(s) identified in this application and we authorize you to contact us at any numbers provided above.

Credit Release Authorization

I hereby certify that the information contained in this credit application is true and accurate and I hereby authorize my bank, trade references, and financial intuitions the right to release credit information. In states where permissible, I hereby authorize the filing and recording of UCC financing Statements showing the Secured Party’s interest in the equipment and grant the Secured Party the right to execute Lessee’s/debtors name thereto. A Photostat/facsimile/digital copy of this authorization shall be as valid as the original.

Signature*

Date*

The Federal Equal Credit Opportunity Act prohibits creditor from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, DC 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Lessor set forth above within 60 days for the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Comments

This field is for validation purposes and should be left unchanged.

Length

Condition

Brand

Year

Mileage

Standard Credit Application

Company Information

Equipment Info (One Piece of Equipment Per Row)

Information on Owner(s), Guarantor(s)

Bank Information

Loan History

Credit Release Authorization