Financing Application

First up, let's get some Business Information

Legal Business Name*

Street address*

City*

State/Region*

Zip code*

Phone number*

Fax number*

Website URL*

Business Structure*

Federal Tax ID*

Years In Business*

Gross Annual Revenue*

Business Description*

Now for some Personal Information

First name*

Last name*

Email*

Phone number*

Date of birth*

SSN (Social Security Number)*

Job title*

Ownership %*

Street address*

City*

State/Region*

Zip code*

Do you Own or Rent*

Company Bank Reference*

Please attach last three months' business bank statements (typically 1st page only with activity summary sections required).

Lease / Loan References*

Please attach a copy of recent monthly payment statement(s) for any term loan or equipment leases.

Vendor & Equipment Information

Vendor Name

Vendor Address

Include full address details including City, State and Zip code.

Amount*

Is your purchase New or Used?*

Equipment Description*

Declaration*

The undersigned individual, on behalf of themselves and all others listed on this application, recognizing that their individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes Quail Capital and any assignee, lender, or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to time, as needed in the credit evaluation and review process, and waives any right or claim they would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent.

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth (for individuals) and other information that will allow us to identify you. We may also ask to see your driver’s license (for individuals) or other identifying documents.

I Accept

I Don't Accept