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: Select State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Telephone: Fax: Tax ID: State of Incorporation: 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 % Telephone Cell SSN Authorized to pull credit Yes No Address: City: Select State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Guarantor #2 Name Title Ownership % Telephone Cell SSN Authorized to pull credit Yes No Address: City: Select State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Equipment and Lease Information Equipment Description (incl Model Info): Vendor: Telephone: Contact: Equipment Cost: Equipment Age (mos): Amount to be Financed: Term Requested: Select Term 24 months 36 months 48 months 60 months Permission to Contact Given By Person completing this form: Telephone: Email: How did you hear about this site OR who referred you: Additional Comments: