1818 N. Taylor St. #354 Little Rock, AR 72207 (501) 375-2822 Office (501) 375-2551 Fax

Application
Once we receive a completed Application we will have one of our Associates contact you!
Contact Information
Business Name						DBA
Business Contact						Email Address
Business Phone Invalid value				Business Fax Invalid value				Mobile Phone Invalid value
Business Address								Tax ID Invalid value
City				County			State Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana 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 Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming			Zip
How did you hear about us? Company Website Facebook Instagram Mailer Other
Business Information
Type of Business					Bus. Start Date			Yrs w/Current Ownership
Last Yr Annual Sales						Current Year-To-Date Sales
Exempt From Sales Tax: Yes No					Ever Declared Bankruptcy: Yes No
Industry				Business Structure			State of Incorp. Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana 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 Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming			# Owners
Company Website

Equipment Summary
Equipment Cost #1			Sales Tax			Term			Monthly Payment
Vendor Name			Vendor Contact			Vendor Phone Invalid value			Vendor Email
Equipment Description
Equipment Cost #2			Sales Tax			Term			Monthly Payment
Vendor Name			Vendor Contact			Vendor Phone Invalid value			Vendor Email
Equipment Description

Signature
Signer:				Title:		Signed At:
By signing below, the undersigned individual, who is either a principal for the credit applicant or a personal guarantor of its obligations, authorizes lessor and/or debtor and their affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or credit worthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit for reviewing or collecting the resulting account. Additionally, I certify that the information contained in this lease application is true and accurate, and in states where permissible, I hereby authorize the filing and recording of UCC Financing Statements showing the Secured Party’s interest in the equipment and grant the Secured Party the right to execute Lessee’s/debtors name hereto. An electronic copy or facsimile copy of this authorization shall be valid as the original. Contacting You; Phone, Email and Text Messages; Call Recordings You authorize us and our assignees and the affiliates, agents, representatives, assigns and service providers of us and our assignees (collectively, the "Message Parties") to contact you using automatic telephone dialing systems, artificial or prerecorded voice messages systems, text messaging systems and automated email systems in order to provide you with information about this Agreement, including information about upcoming payment due dates, missed payments and returned payments. You authorize The Messaging Parties to make such contacts using any telephone numbers (including wireless, landline and VOIP numbers) or email addresses you supply and /or collection of amounts you owe the Messaging Parties or any other matter. You understand that anyone with access to your telephone or email account may listen to or read the messages the Messaging Parties leave or send you, and you agree that the Messaging Parties will have no liability for anyone accessing such messages. You further understand that, when you receive a telephone call, text message or email, you may incur a charge from the company that provides you with telecommunications, wireless and/or Internet service, and you agree that the Messaging Parties will have no liability for such charges. You expressly authorize the Messaging Parties to monitor and record your calls with the Messaging Parties.
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The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract?, because all or part of the applicant's income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Lessor set forth above with 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. Notice: To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify and record information that identifies each person (individuals or businesses) who opens an account. What this means for you: When you open an account or add any additional service, we will ask you for your name, address and taxpayer ID number that will allow us to identify you. We may also ask to see other identifying documents.