Liberty Capital Business Equipment Finance Online Application

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

TERMS, VENDOR & ASSET INFORMATION

Financing Term Desired

Vendor Name

Preferred Buyout

Vendor Phone #

- -

Buying Equipment From?* www.EquipmentReady.com?

Yes No

Vendor Sales Contact

Item #

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 down payments, credit issues, repos & charge-offs, open tax liens, bankruptcies, suits & judgments, additional cosigner available? And, any special requests would help as well.

BANKING INFORMATION

Name of Bank

Business Checking Accnt #

Bank Phone #

- -

Fax #

- -

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. Once transaction has been approved and this transaction is not commenced, or cancelled at the election of the Lessee for any reason, the above stated deposit may be retained in whole or part by us to compensate for our processing, credit investigation, and other general administrative expenses. I also consent to receiving unsolicited faxes and email newsletters, announcements 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.

Owner 1 Signature:
Owner 2 Signature:
Date:	Saturday Feb 04, 2012

Want fast approval? Please fax the following 1. Signed Credit Release (Click Here) 2. Equipment quote or invoice(s) 3. Last 3 months of your bank statements to 866-780-8363.