test Capital Equipment Leasing Application Form Capital Equipment Leasing Application Form Applicant Contact Important: Enter a valid e-mail address. Correspondance will be sent to this address. First and Last Name* Phone* E-Mail:* Referral Partner Referral Partner Company Referral Contact Name Referral Contact Phone Number Your Business Information Full Legal Company Name* Address Line 1:* City:* State:*Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* County: Business Phone:* Fax Number: Cell Phone: Nature of Business(Industry Type) Type of Business* CorporationLLCPartnershipSole proprietorGovernmentNon-Profit Federal Employer Identification Number(EIN) Business Established Date Time in business under current ownership* Location of Equipment Vendor and Equipment Information Amount Requested* Equipment Description Vendor Company Name Preferred Lease TermChoose a Preferred Lease Term12 months24 months36 months48 months60 months Purchase OptionChoose a Purchase Option10%$1.00EFA Sales Representative`s Name Sales Reps Phone###-###-#### Sales Reps Emailname@email.com Guarantor Information (and Business Stakeholders Owning 10% or more) Principal Full Name:* TitleChoose a TitleCEOCOOOwnerPartnerMemberPresidentShareholderSecretaryTreasurerBoard MemberOther Ownership Percentage:* Home Phone Number:* Home Address (Street):* Home Address (City):* State:*Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* Social Security Number:* Principal Full Name: TitleChoose a TitleCEOCOOOwnerPartnerMemberPresidentShareholderSecretaryTreasurerBoard MemberOther Ownership Percentage: Home Phone Number: Home Address (Street): Home Address (City): State:Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Social Security Number: Bank Reference Bank Name Contact Person: Phone: Fax: Account Type Account Number: How Long open?: Acceptance I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE IT`S VERIFICATION AND THE OBTAINING OF A CREDIT REPORT. I understand any false or misleading statements in my application may cause any loan to be in default. I agree that this application shall be this Institutions`s property whether or not this credit application is approved. Please insure this form is signed by all guarantors on this application. By signing below, I stipulate that I agree to all of the terms and conditions stipulated on this application. Signature:* Title* Dated:* Signature: Title Dated: Enter your first and last name in the signature space above. Reset Powered by Elbowspace.com
