EQUIPMENT FINANCING APPLICATION Other Options PDF Application MS Word Application

BUSINESS INFORMATION

Legal Company Name* DBA(doing business as): Business Phone* - - Business Fax - - Business Physical Address* City* State* Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code* Type of Company* Select Sole Proprietorship Partnership LLC Corporation 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 Select Jr Sr III IV V Title* Ownership %* Social Security #* - - Home Phone - - Home Address City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zipcode Home Owner Yes No OWNER 2 Mr Mrs Miss First Name Middle Name Last Name Suffix Select Jr Sr III IV V Title Ownership % Social Security # - - Home Phone - - Home Address City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zipcode Home Owner Yes No

ADDITIONAL INFORMATION

Financing Term Desired Select One Year (12 Months) Two Year (24 Months) Three Year (36 Months) Four Year (48 Months) Five Year (60 Months) Vendor Name Preferred Buyout Select $1.00 10% FMV Vendor Phone# - - Buying Equipment From?* www.equipmentready.com? Yes No Vendor Sales Contact Posting # Equipment Year How did you find us?* Select Search Engine Equipment Ready Site Mailer Word Of Mouth Vendor Truck Paper Trader Publication Machinery Trader Other Internet Site Other 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 # - - 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