Legal Business Name / Federal ID #
Address / City / State / Zip / County
Email Address / Type of Business / Business
Phone #
Ownership Structure
¨ Sole Proprietor ¨ Partnership ¨ Corporation ¨ Other / Time in Business / Business
Fax #
BANK REFERENCES (Bank References should date back 2 years)
Bank / City/State / Phone No. / Account Type / Account No. / Contact
Bank / City/State / Phone No. / Account Type / Account No. / Contact
TRADE REFERENCES
Name / City/State / Phone No. / Account No. / Contact
Name / City/State / Phone No. / Account No. / Contact
OWNERSHIP INFORMATION (List all individuals with 20% or more ownership. Please attach additional pages if necessary)
1) Name
/ Ownership % / AddressSocial Security Number / Title / Cell Phone No. / Phone No.
2) Name
/Ownership %
/ AddressSocial Security Number / Title / Cell Phone No. / Phone No.
3) Name
/Ownership %
/ AddressSocial Security Number / Title / Cell Phone No. / Phone No.
EQUIPMENT DESCRIPTION (New, Used, Make, Model, Serial #)
1) /
Cost
2)
/Equipment Dealer Name and Phone
/Sales Person
CREDIT RELEASE
I (we) hereby authorize DC Financial and related entities: (1) To obtain personal and business credit reports on individuals and entities involved in this transaction. I (we) recognize that my/our individual credit history may be a factor in the evaluation of the credit of the applicant, and hereby consent and authorize the above named business credit provider to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process and waives and right or claim they would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent. (2) To obtain any pertinent information required to reach an underwriting decision, including but not limited to: D & B Reports, Bank and Trade References, Credit Verifications, Financial Reports, Copies of Leases, Tax Returns, and Loan Payoffs. I (we) certify that this application presents a complete, and correct statement of facts as of the date shown and does not omit any pertinent information. I (we) understand that misrepresenting information on this application is a criminal offense. Each entity/person that holds 20% or more of the ownership of the Borrower must sign below. Please attach additional signature pages, if necessary.
DATE: X #
SIGNATURE Phone # where individual can be reached in the next 4 hrs.
DATE: X # SIGNATURE Phone # where individual can be reached in the next 4 hrs.