Equipment Finance Application
Please fax to 800-341-6223
Bold fields are required
Applicant Data: Business Information
Fed Tax ID #:
In business since:
Person to contact:
Ever declared bankruptcy?
(Business or Personal)
Type of Business:
Banking & Credit / Finance References
Nature of Relationship:
Company Principal / Guarantor Information
Description of Equipment to be Financed
Selling Company Name:
Amount Requested: $
Will this equipment be titled?
If yes, in what state?
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 concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. Applicants have the right to receive a statement of specific reasons for adverse actions within 30 days, if the statement is requested within 60 days of the creditor’s oral or written notification of the adverse action. The statement of reasons may be requested by phone at 800-419-0952 or by writing to Priority One Financial Services Equipment Finance, 742 Second Avenue South, St. Petersburg, FL 33701. If the statement of reasons is provided orally, applicants have the right to receive written confirmation within 30 days of our receipt of the applicant’s written request for confirmation.
I certify that the information stated in this application is true and correct. I understand that you will retain this application whether or not it is approved. You and/or entities to whom you refer this application are authorized to check my credit and employment history, obtain insurance information and to answer any questions about your credit experience with me. I authorize you and/or entities to whom you refer this application to contact my creditors and authorize any creditor contacted to release to you such credit information requested.
Terms & Conditions
By checking this box, I certify that I am who I have represented myself to be in this application and that the information supplied is complete and true to the best of my knowledge. I authorize Priority One to obtain any information pertaining to my trade payoff from the lender. I certify that everything stated in this application and on any attachments is true and correct. Priority One and any participating lender may keep this application whether or not it is approved. By initialing below I authorize Priority One and any participating lender to check my credit and employment history and to obtain a consumer credit report in connection with this application or in connection with additional approval, extensions or collection of credit. I understand that I must update application information if my financial condition changes prior to closing of the loan. I am applying for individual credit and are relying on my own income or assets as the basis for repayment of the credit requested. Upon request I will be informed whether or not a consumer credit report was requested and if so the name and address of the agency that furnished such report. Evidence of physical damage insurance on the collateral securing the loan you seek is required prior to closing. By submitting this application you are authorizing us to disclose information contained in your application to an insurance carrier solely for the purpose of providing you with a premium quote for such insurance. You are however under no obligation whatsoever to purchase insurance from the insurance carrier providing the quote. Communication with Priority One Financial Services, Inc. or subsidiaries may be recorded or monitored for training purposes.
Priority One Financial Services, Inc., a Division of Forest River Inc., a Berkshire Hathaway Company