Finance Program #1 Secure Application

CONTACT INFORMATION

Complete Legal Name:
Billing Address:
City:
County
State:
Zip Code:
Daytime Phone:
E-mail:
Contact:

LOAN/LEASE REQUEST

Total $ Amount:
Equipment Description:
Vendor/Supplier:
Address:
City:
County
State:
Zip Code:
Daytime Phone:
E-mail:
Contact:

TYPE OF BUSINESS

Non Profit    Sole Proprietorship    Partnership    Corporation

# of years in business under current owner:

LOCATION OF PROPERTY (if other than Billing Address of Lessee)

Street Address:
City:
County
State:
Zip Code:

PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS

Name:
Title:
Social Security #:
Home Phone:
Home Address:
City:
County
State:
Zip Code:

Are you a US Citizen? Yes     No

(if no, explain status):

BUSINESS/PERSONAL BANK REFERENCES - TWO YEAR HISTORY (important to establish any loan history - attach copies of bank statements)

Name of Bank/Branch:
How Long:
Telephone Number:
Contact:
Checking Account #:
Savings Account #:
Loan Account #:

 

Name of Bank/Branch:
How Long:
Telephone Number:
Contact:
Checking Account #:
Savings Account #:
Loan Account #:

TRADE REFERENCES - TWO YEAR HISTORY (important to establish high credit and payment history)

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

BUSINESS LANDLORD/MORTGAGEE - TWO YEAR HISTORY (important to establish high credit and payment history)

Company Name:
Contact:
Telephone Number:

Insurance Company:
Contact:
Telephone Number:
Referred by:
Express Equipment Finance Account Manager:
Cover Letter
(Explanation of reason for funding)

If your application for business credit is denied, you have the right to a written statement of the specific reason(s) for denial. To obtain the statement, please contact Express Equipment Finance, Scottsdale, AZ, 85260, 1-866-353-2731 within 60 days from the date of our decision. We will send you a written statement of the reason(s) for the denial within 30 days of receiving your request for the statement.

NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against 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 concerning this credit is the Federal Deposit Insurance Corporation, 25 Ecker Street, Suite 2300, San Francisco, CA.

By clicking on the SUBMIT button below, I certify that the above given information given for the purpose of obtaining credit is true and correct. I authorize the person or firm to whom this application is made, any credit bureau or investigative agency employed by such person to investigate the references herein listed or other persons pertaining to my credit. I understand the terms of this instrument are not binding on Express Equipment Finance until accepted in writing by them.