Online Application « AILCO Equipment Finance Group, Inc.

Online Application

Business Information

*(denotes required field)

Business Legal Name *

Federal Tax ID *

Entity (Corp., Sole Prop, Partnership, LLC, Etc.) *

DBA (if any)

Primary Contact *

Title *

Business Phone *

Cell Phone *

Fax

E-Mail Address *

Busness Street Address *

City, State, Zip *

Business Mailing / Billing Address

City, State, Zip

Date Business Started *

Years Under Current Ownership *

Nature of Business *

Primary Bank *

Contact *

Phone # *

Checking Account # *

Revenues *

Net Worth *

Insurance Agent

Phone #

Equipment Information

Equipment Description (new or used) *

Estimated Equipment Cost *

Lease Term *

Equipment Location *

Vendor Name *

Vendor Contact *

Vendor Phone # *

Vendor Address

Principal Information

Principal Name (1) *

Principal Title *

Home Address *

City, State, Zip *

Date of Birth *

Home Phone # *

Percent of Ownership *

Social Security # *

Principal (2)

Principal Title

Home Address

City, State, Zip

Date of Birth

Home Phone #

Percent of Ownership

Social Security #

*By submitting this application, I (we) affirmatively state and agree to the terms of the credit release authorization below

Credit Release Authorization

I (we) hereby certify that the information contained in this lease application is true and accurate and I hereby authorize: i) both my and our banks, trade references, and financial institutions the right to release credit information; and ii) AILCO or its designee to obtain financial information, including consumer or other credit reports related to both my and our company’s credit history or creditworthiness, any credit profile, and to update that information hereafter so long as any amount is owed by the lessee or guaranteed by me to AILCO is outstanding. 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 thereto. A Photostat copy of this authorization shall be as valid as the original. ECOA Notice: If your application for business credit is denied, you have the right to a written statement of the specific reasons for that denial. To obtain that statement, please write to us at: PO Box 710 Brookfield, WI 53008 within 60 days from the date that you were notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of receiving your request for the statement. PLEASE TAKE NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter the 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.

Responsive. Flexible. Secure.

AILCO Equipment Finance Group, Inc.