Enter your e-mail address to receive a confirmation
letter.
Business Information
required
Company Name *
Address Line 1 *
City *
State / Province *
Zip / Postal Code *
Company Phone *
###-###-####
Contact Name *
Contact E-mail
Fax
###-###-####
Business Structure
Date Company Formed (mm/yyyy) *
Federal Tax ID
Comments
Equipment / Lease Details In the Equipment Description
field please include Year, Make, & Model (VIN # if
applicable). You may enter as many pieces of
equipment as you need.
required
Amount *
###.## (minimum amount is
$20,000)
Desired Term Length
Desired Payment
###.##
Equipment Description (year,
make, model) *
Principal(s) / Owner(s)
1 required
Principal(s) / Owner(s) 1 - required
First Name *
Middle
Last Name *
Generation
Ownership % *
### (Do not use a percent sign or decimal.)
SSN / SIN *
###-##-#### / ##-###-####
Birthdate
mm/dd/yyyy
Street Number (home) *
Street Name (home) *
Apartment Number (home)
City (home) *
State / Province *
Zip / Postal Code *
Phone (home) *
###-###-####
Principal(s) / Owner(s) 2
First Name *
Middle
Last Name *
Generation
Ownership % *
### (Do not use a percent sign or decimal.)
SSN / SIN *
###-##-#### / ##-###-####
Birthdate
mm/dd/yyyy
Street Number (home) *
Street Name (home) *
Apartment Number (home)
City (home) *
State / Province *
Zip / Postal Code *
Phone (home) *
###-###-####
Principal(s) / Owner(s) 3
First Name *
Middle
Last Name *
Generation
Ownership % *
### (Do not use a percent sign or decimal.)
SSN / SIN *
###-##-#### / ##-###-####
Birthdate
mm/dd/yyyy
Street Number (home) *
Street Name (home) *
Apartment Number (home)
City (home) *
State / Province *
Zip / Postal Code *
Phone (home) *
###-###-####
Principal(s) / Owner(s) 4
First Name *
Middle
Last Name *
Generation
Ownership % *
### (Do not use a percent sign or decimal.)
SSN / SIN *
###-##-#### / ##-###-####
Birthdate
mm/dd/yyyy
Street Number (home) *
Street Name (home) *
Apartment Number (home)
City (home) *
State / Province *
Zip / Postal Code *
Phone (home) *
###-###-####
Principal(s) / Owner(s) 5
First Name *
Middle
Last Name *
Generation
Ownership % *
### (Do not use a percent sign or decimal.)
SSN / SIN *
###-##-#### / ##-###-####
Birthdate
mm/dd/yyyy
Street Number (home) *
Street Name (home) *
Apartment Number (home)
City (home) *
State / Province *
Zip / Postal Code *
Phone (home) *
###-###-####
Bank Reference
required
Bank
Branch
Phone
###-###-####
Fax
###-###-####
Name on Account
Current Balance
Trade References
Trade References 1
Business Name
Contact
Phone
###-###-####
Account Number
Trade References 2
Business Name
Contact
Phone
###-###-####
Account Number
Trade References 3
Business Name
Contact
Phone
###-###-####
Account Number
Trade References 4
Business Name
Contact
Phone
###-###-####
Account Number
Trade References 5
Business Name
Contact
Phone
###-###-####
Account Number
Equipment Seller Info
required
Equipment Seller Name
Address
City
State
Zip
Phone
###-###-####
Sales Rep
Email
name@company.com
Authorization
required
By checking this
box, each undersigned individual(s), who is either a
principal of the credit applicant listed below or a personal
guarantor of its obligations, provides written instruction
to EPS Equipment Financing 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. A photostatic or facsimile
copy of this authorization shall be as valid as the
original.
In order to submit this application, please key in the
access code you see displayed to the left.
To cut down on spam and protect the privacy of our
customers, we have implemented this process. The access code
you see is provided in graphic format and cannot be read by
a malicious script. By taking a moment to key in the access
code you are doing your part to eliminate SPAM.
Financing is for equipment
that is to be used for business purposes, and is calculated
using a two (2) payment advance: 1st and Last Payment, which
is held as a Security Deposit. Quoted payments do not
include Taxes, Maintenance, or Insurance. Quotes are subject
to credit approval and may change without notice. Quotes are
for good credit. Rates and structure may change by weaker
credit. Terms for startup companies may structure
differently depending on industry and strength of Lessee.
