Credit Application

Please provide the following information (Items marked * are required):

Company Information
Legal Company/Farm Name*
Tax ID#*:
Company Address*
City*
State*
Zip*
Authorized Signer*
Title
Company Telephone*
Business Structure (Choose one)*
 S Corp C Corp LLC Corp Sole Proprietor
Years in Business*

 

Personal Information
Name*
Phone Number*
Social Security #*
Ownership*
%
Rent or Own*
 Own Rent
Home Address*
City*
State*
Zip*
Name
Phone Number
Social Security #
Ownership
%
Rent or Own
 Own Rent
Home Address
City
State
Zip

 

Equipment Description
Term Requested: (Months)*
12 24 36 48 60 72 
Loan Amount* (estimated, $5000 minimum)
$
Equipment Name*
Additional Equipment Names

Declaration
The undersigned represents that all information provided with this Application is true and correct and hereby authorizes Partners Capital Group, to obtain from third parties, information it deems necessary to arrive at a decision regarding this Application. By submitting this form, the undersigned individual(s) as principal of and/or guarantor for the applicant, authorizes Partners Capital Group, its designee, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering this Application and for the purpose of update, renewal, or extension of credit to the Applicant or the to be released by telephone or fax. A photocopy or fax of this authorization shall be valid as the original. To help fight terrorism and money laundering, Federal Law requires banks to verify the information you provide, which may include driver's license or other documents, to identify you.

Applicant (Full Name)*
Title*
Cell/Telephone*
E-mail*

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