Smart Business Credit Application for Financing

BUSINESS INFORMATION

Legal Business Name: 🛈

Business Address *

Floor/Suite:

City: *

State: *

Zip Code *

Phone Number: *

Email Address *

Federal Tax ID:

Type of Business: *

Time In Business (Yrs): *

Owner Type: *

Does at least one owner have a valid DRIVERS LICENSE? *

Do any owners have a CDL *

Is at least one owners a US CITIZEN *

If you are a trucking company how many other commercial trucks do you have? : *

BUSINESS OWNERSHIP

First Name: *

Last Name: *

Title:

Social Security #: *

Home Address:

Floor/Suite:

City: *

State: *

Zip Code *

Phone Number: *

Email Address

% of Ownership: *

2nd Name:

Title:

Social Security #:

Home Address:

City:

State:

Zip Code

Phone Number:

% of Ownership:

EQUIPMENT

Dealership:

Contact:

Phone Number:

Vendor Address:

Floor/Suite:

City

State:

Zip Code

Amount $: *

Preferred Loan Term:

Available Down Payment$: *

Total Monthly Deposits for the last 3 months:

Equipment Description and Comments (Year/ Make/Model Helpful if possible):

Credit Authorization Agreement *

[ x ] I/ we agree that by submitting this form, I (we), the undersigned individual, recognize that his or her individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes the above named business credit provider and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent.