EQUIPMENT FINANCING APPLICATION

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BUSINESS INFORMATION
Legal Company Name* DBA(doing business as):
Business Phone*
- -
Business Fax
- -
Business Physical Address* City*
State* Zip Code*
Type of Company* Federal I.D No.
Cell phone
- -
Email Address

Time in Business (Under Current Ownership)?*   Years: Months:

OWNER 1
Mr Mrs Miss
First Name*
Middle Name
Last Name*
Suffix
Title*
Ownership %*
Social Security #*
- -
Home Phone
- -
Home Address
City
State
Zipcode
Home Owner Yes No
OWNER 2
Mr Mrs Miss
First Name
Middle Name
Last Name
Suffix
Title
Ownership %
Social Security #
- -
Home Phone
- -
Home Address
City
State
Zipcode
Home Owner Yes No
ADDITIONAL INFORMATION
Financing Term Desired Vendor Name
Preferred Buyout Vendor Phone#
- -
Buying Equipment From?* www.equipmentready.com?
Yes No
Vendor Sales Contact
Posting # Equipment Year
How did you find us?* Equipment Make
If Other Please Explain Equipment Model
Equipment Cost
Any additional information you would like us to know about you & your company? Such as repossession, open tax liens, bankruptcies, suits & judgment, additional cosigner available?
BANKING INFORMATION
Name of Bank
Business Checking Accnt #
Bank Phone #
- -
Fax #
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Contact

* By checking this box, the Applicants represent and warrant that all credit and financial information submitted is true and correct.
I hereby authorize the release of all credit information to and consent to the obtaining and use of my consumer credit report by any agency involved in securing funds for the above company, their designee, assigns/potential assigns at anytime, for obtaining credit and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. I understand that this information may be transmitted by us to you and by you to assign(s) for the purpose of granting to me credit, either electronically or manually and that by submitting this application, I take full responsibility for transmission thereof. I also consent to receiving unsolicited faxes and email wherein the involved agency will advocate its services. I acknowledge my rights under the Fair Credit Reporting Act and The Patriot Act which now requires two forms of Identification and Date of Birth.

Electronic Signature: (we may require your original signature later)
Owner 1 Signature:
Owner 2 Signature:
Date: Thursday Aug 28, 2008