Business Direct Capital
equipment finance application


Business Information  
*COMPLETE LEGAL NAME OF COMPANY
*FEDERAL TAX ID (XX-XXXXXXX)
*DATE STARTED (MM/DD/YY)
D&B NUMBER
*DESCRIPTION OF WHAT COMPANY DOES
WEBSITE
*BUSINESS STRUCTURE (Check One) Proprietorship Partnership Corporation LLC Other
STATE OF INCORP (two letter state code)
*COMPANY ADDRESS
STREET
CITY
 STATE ZIP
*TELEPHONE (555-555-5555) EXT
*FAX (555-555-5555) EXT
*EMAIL OF CONTACT PERSON
Bank and Trade Information  
BUSINESS BANK
CONTACT PERSON
ACCOUNT #
TELEPHONE (555-555-5555) EXT
AVG BALANCE (last 90 days) $
TRADE REFERENCE #1 CONTACT PERSON
ACCOUNT#
TELEPHONE (555-555-5555) EXT
TERMS NET 30 OTHER
TRADE REFERENCE #2 CONTACT PERSON
ACCOUNT#
TELEPHONE (555-555-5555) EXT
TERMS NET 30 OTHER
OTHER BUSINESS LOAD OR EQUIPMENT LEASE REFERENCE
ACCOUNT#
TELEPHONE (555-555-5555) EXT
ORIGINAL LOAN AMOUNT $
Owner Information  
*PRINCIPAL/OFFICER PARTNER #1
*TITLE
*OWNERSHIP %
*SOC. SEC. # (XXX-XX-XXXX)
CURRENT DEROGATORY ACCTS ON CREDIT REPORT? Yes No
If Yes, $ past due
*COMPLETE HOME ADDRESS
STREET
CITY
 STATE ZIP
  Own Rent
PRINCIPAL/OFFICER/PARTNER #2
TITLE
OWNERSHIP%
SOC. SEC. # (XXX-XX-XXXX)
CURRENT DEROGATORY ACCTS ON CREDIT REPORT? Yes No
If Yes, $ past due
COMPLETE HOME ADDRESS
STREET
CITY
 STATE ZIP
  Own Rent
PRINCIPAL/OFFICER/PARTNER #3
TITLE
OWNERSHIP %
SOC. SEC. # (XXX-XX-XXXX)
CURRENT DEROGATORY ACCTS ON CREDIT REPORT? Yes No
If Yes, $ past due $
COMPLETE HOME ADDRESS
STREET
CITY
 STATE ZIP
  Own Rent
Equipment & Vendor Information  
EQUIPMENT VENDOR - CONTACT PERSON
TELEPHONE (555-555-5555) EXT
EMAIL
RESALE NUMBER
*EQUIPMENT DESCRIPTION
*# OF PIECES
*NEW OR USED New Used
*TOTAL COST
WORKING CAPITAL
Do you need working capital for other items? Yes No $25K $50K $75K $ 100K
By checking this box, each individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Business Direct Capital or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purpose of update, renewal or extension of such credit and for reviewing or collecting the resulting account. By clicking the Submit button below, the electronic submission of this authorization shall be as valid and act as the original authorization and signature. 
 
*required information
888.305.9292