Application

We offer quick decisions on most situations, one-page credit applications, competitive rates, and our many years of experience allows us to be very creative with our financing and leasing. Oh, yes, we are extremely courteous with service "second to none."

If the amount is less than $100K, the application is the only information we need. If it exceeds this amount, a complete financial package is required. For businesses less than 2 years in business, $25K is the maximum amount.

1. Company Information

Company:

DBA:

Business Address:

Address:

City:

State:

Zip code:

Phone number:

Years in Business:

Federal ID Number:

Nature of Business:

Number of Employees:

Contact Person:

Contact Person's Email Address:

Type of Business:

2. Personal Information on Officers, Partners, or Guarantors

First Officer, Partner, or Guarantor:

Name:

Social Security Number:

Title:

Home Phone:

Home Address:

City:

State:

Zip Code:

Second Officer, Partner, or Guarantor:

Name:

Social Security Number:

Title:

Home Phone:

Home Address:

City:

State:

Zip Code:

3. Company Bank References

First Bank:

Bank Name & Branch:

City:

State:

Zip Code:

Checking Account Number:

Loan Account Number:

Telephone:

Contact Officer:

Second Bank:

Bank Name & Branch:

City:

State:

Zip Code:

Checking Account Number:

Loan Account Number:

Telephone:

Contact Officer:

4. Trade References

First Supplier:

Supplier:

City:

State:

Zip Code:

Telephone:

Account Number:

Second Supplier:

Supplier:

City:

State:

Zip Code:

Telephone:

Account Number:

5. Vendor Information

Vendor Name:

Address:

City:

State:

Zip Code:

Telephone:

Fax:

Contact Person:

Price:

Term:

Monthly Payments:

Sales Tax:

Factor:

$1 Purchase Offer:

Advance Payments:

10% Purchase Option:

6. Additional Comments and Submit

Questions/Comments:

Equipment Description:

Release: I verify the accuracy of the above information and authorize Equities Funding Group, Inc. and its assigns to contact trade references, credit bureaus, financial institutions and my bank(s) to verify the acceptability of my credit.

Name:

Title:

Date: