6465 Wayzata Blvd
Suite 760
St. Louis Park, MN 55426
PH 877-227-6842 / FAX 888-678-1249
Credit Application
Company Information
Last Name / Company Name
Street Number
Street Name
StreetSuffix
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Lousiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvannia
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
County
Phone Number
Fax
Applicant Contact Information
Primary Contact
Title
Phone
E-mail Address
Business Financial Summary
Federal ID / SSN Number
Business Type
C-Corp
LLC
Other
Partnership
Professional Corporation
Public Corporation
S-Corp
Sole Prop
Years In Business
Owner Years
Last Fiscal Year Sales
Last Fiscal Year Net Income
Estimated Current Year Sales
Estimated Total Assets
Est Average Checking Balances
Est Outstanding Loan Balances
Officer - Owner Information
Add
First Name
Last Name
Title
Social Security #
% Ownership
Phone Number
Street Number
Street Name
Street Suffix
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Lousiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvannia
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
County
Bankruptcy in Last 7 Years
No
Yes
Liens/Judgments/Suits
No
Yes
Other Controlling Interests
No
Yes
Application Summary
Eq Desc/Purpose of Financing
New or Used
New
Refurb
Used
Estimated Costs
Down Payment
Desired Term
24
36
42
48
60
72
75
Vendor or Seller's Name
Vendor Contact
Vendor Phone Number
Request Additional Credit?
No
Yes
Desired Amount
Purpose of Additional Funds
e-signatures of Officers/Owners/Guarantors
1st Person Authorizing Signature
2nd Person Authorizing Signature
Financial Document Uploads
If available and applicable, please upload any additional confidential documents relevant to this credit application.
By signing this document, I/we hereby authorize your company to review my personal and business credit profile for the purposes of obtaining credit. In addition, I/We authorize and instruct any person, consumer reporting agency, or bank institution to compile and furnish your company, or its assignee(s) with any information it may have in response to an inquiry from a lessor or creditor. I/We certify that the information provided in this application is true and correct and understand a facsimile, electronic, or other copy of this document shall be valid as the original.
Security Check
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SUBMIT APPLICATION
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No
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