Contract Entry

(Hidden) Vendor and Sales Rep

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Vendor:

(Hidden) Sales Representative

Restore

Sales Rep:

Credit Application

Company Information (Fields in Bold are Required)

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1 Customer(s) are required

Customer 1

Business Legal Name:

Business Legal Name is required

DBA:

Federal Tax ID:

Federal Tax ID is requiredFederal Tax ID is not valid.

Address:

Address is required

City:

City is required

State:

State is required

Zip Code:

Zip Code is required

Phone:

Phone is required

Fax:

Contact:

Contact is required

E-mail:

E-mail must be a valid email address

State of Incorporation:

State of Incorporation is required

# of Years in Business:

# of Years in Business is required

Business Type:

Business Type is required

Customer ID:

Enter Owners (20% or more)

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Owner 1

Business

Individual

First Name:

First Name is required

Middle Name:

Last Name:

Last Name is required

Suffix:

Primary Address:

Primary Address is required

City:

City is required

State:

State is required

Zip Code:

Zip Code is required

Date of Birth:

SSN #:

SSN # is not valid.

Percent Ownership:

Percent Ownership is required

Add Additional Owner

Equipment Description (add equipment being purchased)

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Equipment List

No equipment has been added.

Add/Edit Equipment

Quantity:

Quantity is required

New/Used:

New/Used is required

Make:

Make is required

Model:

Model is required

Equipment Cost:

Equipment Cost is required

Equipment Location:

Equipment Type:

Add Equipment:

Cancel

Finance Term and Downpayment

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Term in Months:

Down Payment:

Equipment Reference

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Equipment Reference 1

Type:

Credit Finance Company Name:

Contact:

Phone:

Authorization for Release of Credit Information

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The undersigned individual(s) certifies the following: (1) the information provided in connection with this application is true and accurate and has been submitted to obtain commercial credit; (2) Dealer and Engs Finance Corp. (“ECF”), jointly or separately, are authorized to investigate and verify any information provided and to make inquiry of references, other creditors or lessors as to credit worthiness; (3) applicant(s), guarantor(s), owners, principals, named above, (hereafter referred to as “Customer”) and/or any individual whose name appears on the application explicitly authorizes any consumer reporting agency and other individuals to provide credit information to Dealer and ECF for use in connection with the transaction. Dealer, ECF and other parties engaged for capital markets purposes are authorized to receive, exchange and to update such credit information as appropriate during the term of the transaction. ECF will require proof of identity as required under the USA Patriot Act. Please direct any questions/requests to ECF ATTN: Chief Risk Officer, at industrial@engsfinance.com. Please include your social security number so we can track to your application.

I agree to the terms listed above:

Submitted By:

Submitted By is required

Title:

Title is required

Equal Credit Opportunity Act

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NOTE: You have the right to a written statement of the specific reasons for the denial, if your application is declined. Please contact ECF at industrial@engsfinance.com within 60 days from the date you are notified of our decision for a written statement. A written statement of decline reasons will be sent to you within 30 days of receiving your request. The Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, religion, national origin, color, sex, marital status, age or other discriminating basis. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. Applicant(s) and/or any guarantor(s) have read and agree to the above ECOA consent and notice.

Click Here to Submit Application

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Submit Application

Print Application

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Questions

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Contact: Ben Gudeman, 317-612-9976 bgudeman@engsfinance.com

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