Finance Application

For faster decision please complete as much information as possible. All the required (*) information is required to submit the application.

If you prefer to fax your application you may download the PDF Application here and fax to 1-866-591-6537 DOWNLOAD HERE File Format Pdf-507x507

 

Equipment Vendor Information

  Equipment Vendor :   (company you are purchasing equipment from)
  Equipment Sales Representative:  
  Equipment Description:  
  Equipment Cost: $
 

Business Information
(if startup Business, fill in info you know)

  Company Name:  
  DBA (if any):  
  Address:  
  City:  
  State:  
  Zip:  
  Phone:  
  Annual Business Revenues Before Taxes and Expenses:  
  Email:  
* Date Business Established:   (If new business, please note “start-up”)
  Structure of Business:  
  Tax ID #:  
  Federal Descriptions of Business:  
  Equipment Location: (if different from above)  
 

Information on Principals

Principal 1

* Your Name:  
  Title:  
* Social Security Number : #
* Date of birth : #
* Drivers License number: #
* State Issued:  
* Address:  
* City:  
* State:  
* Zip:  
* Do you:   RentOwn
  Percentage of Business ownership:  
  Place of Employment:  
  Home Phone:  
  Cell Phone:  
  Work Phone:  
* Email:  
  Has the applicant or any guarantor ever had:   RepossessionBankruptcyJudgementNone
 

Principal 2(If applicable, fillout completely)

  Name:  
  Title:  
  Social Security Number: #
Date of birth : #
Drivers License number: #
State Issued:  
  Address:  
  City:  
  State:  
  Zip:  
  Do you_:   RentOwnN/A
  Percentage of Ownership:  
  Place of Employment:  
  Home Phone:  
  Cell Phone:  
  Work Phone:  
  Email:  
  Has the applicant or any guarantor ever had:   RepossessionBankruptcyNoneN/A
 

Personal References

(Closest relative not living with you)

  Name:  
  Phone Number:  
  Address:  
 

Additional Personal Reference

  Name:  
  Phone Number:  
  Address:  
 
The applicant(s) certifies that all information contained in this application, and all attachments hereto, are true and complete to the best of the applicant(s) knowledge, and are made for the purpose of obtaining credit for business purposes, and not for personal or family use. The applicant(s) hereby authorize Adia Capital and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the each Guarantor contained herein, now, from time to time, and at any time in the future, as may be needed in the credit evaluation and review process and waives any right or claim the applicant(s) would otherwise have under the Fair Credit Reporting Act in absence of this continuing consent. The applicant(s) further authorize any bank, financial institution or trade reference to release credit information on the applicant(s) account(s) ACL. and/or its assigns. An electronic, photocopy or facsimile copy of this authorization with a copied, electronic or facsimile signature shall be deemed to be binding, valid, genuine and authentic as an original-signature document for all purposes. A non-refundable documentation fee will be required for the preparation and distribution of lease documents.




* Please select I AGREE or I DISAGREE in the following box to acknowledge your authorization.

I AGREEI DISAGREE

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