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Filed bankruptcy in the last 10 years?
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Open liens or judgements?
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Repossession?
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Describe Nature of Business/ Present Operation
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Financial Information
Requested Amount
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Requested Amount for Equipment (List All)
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Fleet Information
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Fleet Size
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Subsidiary or Affiliate Names
Name
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State of Operation
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Guaranty Available
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Management / Ownership
Name
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Title
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% of Ownership
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Assets Pledged
*
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Equipment Finance References
Bank Name
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Contact Name
*
Full Name
Phone
*
Email
*
Account Number
*
Balance
*
The undersigned certifies that the above information given for credit purposes is true and correct and authorizes Equify, LLC, its subsidiaries, and their assigns or potential assigns or any other lender that this application is submitted to (collectively “EQUIFY”), to investigate the references, statement, or other data listed or accompanying this application about the undersigned’s accounts and credit experience. EQUIFY may receive from and disclose to other persons, including any credit bureau or investigative agency, information about the undersigned’s accounts and credit experience. The undersigned authorizes all parties contacted to release credit and financial information requested as part of said investigation. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on the undersigned by EQUIFY or any person requested to release such info to EQUIFY. 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 (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law or concerning this creditor is: Federal Trade Commission, Equal Credit Opportunity, Washington D.C. 20580. If application for credit is denied, applicant may, within 60 days of being notified of the adverse action, submit a written request for the reasons for the denial and the reasons will be furnished in writing within 30 days of receipt of applicant’s request. Submit request to: Credit Manager, Equify Financial, LLC, 777 Main Street, Suite 3900, Fort Worth, TX 76102.
Consent For Use Of A Consumer Credit Report
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I AGREE
You understand that by clicking on the I AGREE button immediately following this notice, you are providing ‘written instructions’ to (Third Party) and any lender to whom (Third Party) forwards this application in connection with this application for commercial lending under the Fair Credit Reporting Act authorizing (Third Party) and any such lender to obtain information from your personal credit report or other information from Experian. You authorize (Third Party) and any such lender to obtain such information solely in connection with this application for commercial lending.
Applicant Name
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Full Name
Recognizing that my personal credit history may be a factor in the evaluation of the credit history or credit worthiness of Applicant Name (the “Credit Applicant”) or in the evaluation of my personal guarantee of the obligations of the Credit Applicant (if applicable), I hereby authorize Equify, LLC, and its subsidiaries, and their assigns or potential assigns or any other lender thereof (collectively, “EQUIFY”) to obtain and use consumer credit reports pertaining to my credit history and/or credit worthiness from any credit reporting agency for use in connection with the Credit Applicant’s application for the extension of business credit by EQUIFY.
Name
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Date
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Address
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Street Address
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Date
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