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Please supply as much information as you can.
Doing so will help us to expedite your Business Equipment Financing request.

Business Information
Company Name: Sole Proprietor Partnership LLC Corporation
DBA (If Any): Business Type: Years in Business:
Mailing Address: City: Zip:
Telephone: Fax: Tax ID: State of Incorp.


Bank Information
Bank #1 Name City Telephone
Contact Name Checking Acct Number
Date Opened Average Balance


Guarantor Information (anyone with a 10% or more ownership in the company MUST be a guarantor)
Guarantor #1 Name Title Ownership %
Tel. Cell SSN Authorized to pull credit Yes No
Address: City: Zip:

Guarantor #2 Name Title Ownership %
Tel. Cell SSN Authorized to pull credit Yes No
Address: City: Zip:


Equipment and Lease Information
Equipment Description (incl. Model Info):
Vendor: Telephone: Contact:
Equipment Cost: Equipment Age (mos):
Amount to be Financed: Term Requested:


Permission to Contact Given By
Person completing this form: Telephone: Email:
How did you hear about this site OR who referred you:
Additional Comments: