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Business Credit Application
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Business
Business Legal Name
DBA
(If applicable)
Business Street Address
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ZIP
City
State
Phone #
Email
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Website
Sole Prop
Partnership
LLC
Corporation
Municipal
Not For Profit
Legal Structure
Federal Tax ID
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT COLUMBIA
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
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
State of Inc./Formation
$
Gross Annual Revenue in Prior Fiscal Year
You entered revenue equal to or greater than $50 million. Please re-enter if not correct.
# of Workers
You entered # of Workers equal to or greater than 100. Please re-enter if not correct.
Date Business Started Under Current Ownership
The date you entered is more than 50 years ago. Please re-enter if not correct.
Auto Aftermarket
Beauty Salon, Spa
Bowling Center
Car Wash - Stand Alone
Child Care
Chiropractor
Construction
Dentist, Orthodontist
Education
Equipment Rental / Sales
Fitness
Full-Service Restaurants
Gasoline Stations
General Rental Centers
Grocery and Convenience Stores
Healthcare
Hotel and Motels
Laboratories
Landscape
Manufacturing
Meat Markets
Mining, Quarrying, and Oil and Gas Extraction
Misc Retail
Other Grocery and Related Products Merchant Wholesalers
Physician
Printing
Professional Services
Restaurant - Franchise
Technology Support, Telecomm, Software
Trucking Local Haul
Trucking Long Haul
Veterinary
Industry Type
Equipment & Vendor
Equipment
$
Finance Amount
$
Total Project/Equipment Cost
24
36
48
60
72
84
Term (in months)
New
Used
New or Used
Will the above address also be the equipment address?
Yes
No
Equipment Address
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ZIP
City
State
Vendor Name
Address
ZIP
City
State
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Vendor Website
Contact Name:
Phone
Email
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