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.
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Indicates a required field.
Business Information
Legal Name:
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DBA (if applicable):
Nature of Business:
Federal Tax ID # OR Social Security #:
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Select
Federal Tax ID #
Social Security #
Entity Type:
Corporation
S-Corporation
Partnership
LLC
Sole Proprietor
Other
Date Business Started:
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Years Under Current Ownership:
Proof of Existence:
Physical Address:
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City/State/Zip:
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Mailing Address:
City/State/Zip:
Primary Contact:
Title
Phone #:
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Fax #:
Cell #:
Email:
*
Website:
Do you factor freight bills?
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Select
Yes
No
Equipment Information
Equipment Description:
Condition:
New
Used
Lease Term:
Tax Exempt:
Yes
No
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:
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First Name:
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Middle Initial:
SSN:
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Date of Birth:
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Employer/Title:
Physical Home Address:
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City/State/Zip:
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Country:
Home Phone #:
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Cell Phone #:
Work Phone #:
Email:
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Citizen Status:
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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.
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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
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Date
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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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