Application

Application

"*" indicates required fields

Customer Information

Address*
Equipment Location (if different than corporate address)
Type of Business*
Full Name of Officer Signing Documents*

Vendor & Equipment

Vendor Contact*
Condition*
Term*

Credit Release & Ownership Information

Please list all with over 20% ownership.

Owner #1*
Address*

Owner #2
Address
Equipment Location (if different than corporate address)

Owner #3
Address

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (providing that the applicant has the legal capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, EQUAL CREDIT OPPORTUNITY, Washington, D.C. 20580.