Equipment Finance Application
Questions? Call us at 1-800-419-0952
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?
Where did you hear about us or what dealer are you working with?
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.
Priority One Financial Services, Inc., a Division of Forest River Inc., a Berkshire Hathaway Company