Equipment Leasing Application

COMPANY INFORMATION (Please list Legal Name. If there is a d/b/a please indicate)
 Legal Name of Company :
 Business Address :
 City : State: Zip:
 Billing Address (if different from above) :
 City: State:  Zip:
 Phone:   Fax :  Cell:
 Contact's Full Name :  Website:   E-Mail Address :
 Time in Business :  Yrs    Fed Tax ID #:    # of Employees:
 Nature of the Business :   Type of Business :
 

OWNER DATA (Please indicate all owners with greater than 25% ownership) Attach list if needed
  Principal #1 Full Name   Address :
  Principal 1 percentage of Ownership
  City/State/zip :   Social Security # :
  Rent or own?   How Long 
  Principal #2 Full Name   Address :
  Principal  2 Percentage of Ownership
  City/State/zip :  Social Security # :  
   Rent or own?     How Long 
 

REFERENCES (If you have a Company Reference List, skip this section and attach)
  Business Bank :   Account #
  Bank Contact :   Phone:  Fax: 
  1. Trade Reference :   Phone :
  2. Trade Reference :   Phone :  
 
VENDOR'(S) and EQUIPMENT (If more than one Vendor, attach List of Vendor's & Proposals)
  Vendor Name :   Phone:
  Address :
  Equipment : Equipment Cost:   Is the Equipment New or Used    
 
Please upload/attach a copy of the Vendor Proposal, Invoice or Purchase Order with full description here:  (Please attach either .pdf, .zip, .doc., .gif, .jpg, .xls file formats only)
 

LEASE STRUCTURE (Please enter the lease structure you are requesting)
  Lease term in Months:   End of Lease Option:
The undersigned: (1) Certifies that the information supplied on this application is true; (2) As the principal(s) of and guarantor(s) for the applicant, authorizes First Capital Funding Corporation, and its designee's, to review his/her personal credit profile and to updating credit in the future; (3) Certifies that the financing sought will be used for business purposes and not for personal family or household purposes; (4) Authorizes all parties set forth above to release credit information by a verbal authorization, fax copy, or electronic submission of this document. If your application for business credit is denied, you have the right to a written statement of the reasons for the denial. To obtain the statement please contact First Capital Funding Corporation at 3175 Starbright Court, Suite D, Middleburg, FL 32068 within 60 days from the date you are notified of our decision. 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, because all or part of the applicant's income derives from any public assistance program; or because the applicant has exercised any right under the Consumer Credit Protection Act. The federal agency that administers this law concerning the creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580.
 
Signature: Title: Date: