Equipment Finance Application
Your session will time out after 30 minutes of inactivity. However, you will receive a 2 minute warning message prior to this occurring, where you will have the opportunity to extend your session.
*
Indicates a required field.
Business Information
Legal Name:
*
Enter Legal Name
DBA (if applicable):
Nature of Business:
Federal Tax ID # OR Social Security #:
*
Select Federal Tax ID or Secial Security #
Enter Tax ID or Social Security #
Select
Federal Tax ID #
Social Security #
Entity Type:
Corporation
S-Corporation
Partnership
LLC
Sole Proprietor
Other
Date Business Started:
*
Enter Date Business Started
Years Under Current Ownership:
Proof of Existence:
Physical Address:
*
Enter Physical Address
City/State/Zip:
*
Enter City/State/Zip
Mailing Address:
City/State/Zip:
Primary Contact:
Title
Phone #:
*
Enter Phone #
Fax #:
Cell #:
Email:
*
Enter Email
Website:
Do you factor freight bills?
*
Select Yes/No
Select
Yes
No
Equipment Information
Equipment Description:
Condition:
New
Used
Lease Term:
Tax Exempt:
Yes
No
Estimated Equipment Cost:
*
Enter Estimated Equipment Cost
Equipment Location:
Where Will Equipment Be Stored:
Vendor Name:
Vendor Address:
City/State/Zip:
Vendor Contact Name & Phone #:
Owner Information
Information
Owner % Of Ownership:
Last Name:
*
Enter Last Name
First Name:
*
Enter First Name
Middle Initial:
SSN:
*
Enter SSN
Date of Birth:
*
Enter Date of Birth
Employer/Title:
Physical Home Address:
*
Enter Physical Home Address
City/State/Zip:
*
Enter City/State/Zip
Country:
Home Phone #:
*
Enter Home, Cell, or Work Phone #
Cell Phone #:
Work Phone #:
Email:
*
Enter Email
Citizen Status:
*
Select Citizen Status
U.S. Citizen
Resident Alien
Non-Resident Alien
ID Type:
Driver's License
Government ID
Passport
VISA
Other
ID #:
Place of Issuance:
Issue Date:
Expiration Date:
Additional Owner Information
Application Intent
Initial here indicating your intent to apply for credit. If you are applying for joint credit, please provide initials for each additional owner.
*
Enter joint credit initials
Acknowledgment
The undersigned certifies that the information contained in this financing application is true and correct and authorizes FirstLine Funding Group, a division of First Bank & Trust, Sioux Falls, SD and Fishback Financial Corporation, its affiliates, subsidiaries or person to whom this application is made and any credit bureau or investigative agency for purpose of credit investigation of the company I represent or myself. This shall be continuing authorization for all present and future inquiries and disclosures of account information and credit experience for the undersigned. I represent that this application is submitted for a purpose other than to obtain monies for personal, family or household use.
Applicant Signature
*
Enter Signature
Date
*
Enter Date
The undersigned certifies that the information contained in this financing application is true and correct and authorizes FirstLine Funding Group, a division of First Bank & Trust, Sioux Falls, SD and Fishback Financial Corporation, its affiliates, subsidiaries or person to whom this application is made and any credit bureau or investigative agency for purpose of credit investigation of the company I represent or myself. This shall be continuing authorization for all present and future inquiries and disclosures of account information and credit experience for the undersigned. I represent that this application is submitted for a purpose other than to obtain monies for personal, family or household use.
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