Equipment Lease Commercial Application - Assured Capital Funding, LLC

Commercial Equipment Lease Financing Application

Use this form to apply for a business equipment lease from amounts of $2000.00 to $75,000.00. If you have a sale's invoice, you may upload a copy at the bottom of the application form. Please contact us for leasing "Over the Road" vehicles or equipment purchases of higher than $75,000.00.

Legal Business Name*

DBA Name

Business Street Address*

City State Postal / Zip Code

Business Phone*

Area Code

Phone Number

Secondary Phone

Area Code

Phone Number

Time in business (years/months)*

Business Type*

Billing Address (if different)

City State Postal / Zip Code

Federal ID# *

Business Contact*

First

Last

Business Contact Email Address*

Confirm Business Email*

Equipment Information

Equipment Type*

Equipment Description: (Quantity, Manufacture, Model, Serial #) *

Equipment Condition*

New

Used

Reconditioned

Total Equipment Cost*

Dealer/Vendor Name

Dealer/Vendor Phone #

Area Code

Phone Number

Salesperson

Business Owner(s) Information

Business Owner/Guarantor 1 Full Name*

Title*

% of ownership*

Social Security #*

Date of Birth*

day

month

year

Home Street Address*

City State Postal / Zip Code

Home Phone*

Area Code

Phone Number

Secondary Phone #

Area Code

Phone Number

Guarantor 2 Full Name (must be part owner)

Guarantor 2 Title

Guarantor 2 % of ownership

Guarantor 2 Social Security #

Guarantor 2 Date of Birth

day

month

year

Guarantor 2 Home Street Address

City State Postal / Zip Code

Guarantor 2 Home Phone

Area Code

Phone Number

Guarantor 2 Secondary Phone #

Area Code

Phone Number

Please Authorize:

* The undersigned applies for the lease indicated in this application. Everything stated in this application is correct. Assured Capital Funding, LLC may retain the application whether or not the lease is approved. Assured Capital Funding, LLC and its Authorized Affiliates are authorized to check my credit and employment history for the purposes of determining my credit worthiness at the time of my application or thereafter in connection with the same transaction or extension of credit and for the further purpose of reviewing the account.

I Agree to the terms above.*

Authorized Signature *

Date*

I Agree to adopt this typed representation of my name as my signature*

Send a copy of this message to yourself

Upload sale's invoice if you have one.