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484-879-1810

APPLY NOW - ONLINE CREDIT APPLICATION
(or Download a PDF and fax to 484-879-1811).

Fields marked in BOLD are required in order for your application to be processed.
 
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BUSINESS INFORMATION
Business Name:
Business Address:         Floor/Suite:
City:   State:   Zip:     Phone:
Type of Business:         Federal Tax #:
Time In Business under Current Ownership: Yrs.

EQUIPMENT
Vendor:     Contact:
Vendor Address:         Floor/Suite:
City:   State:   Zip:     Phone:
Equipment Type: New   Used          Amount: $
Buyout Options: $1     10%     FMV
Type of Equipment:     Term (months): 24  36  48  60
Equipment Description:

BANK INFORMATION
Bank Name:     Branch:
Phone:         Bank Officer:
Business Checking Account #:
Loan Account #:

TRADES
Supplier:
Contact:           Phone:
Supplier:
Contact:           Phone:

BUSINESS OWNERSHIP
Owner Type: Sole Owner   Partnership   Corporation   LLC   LLP   Other
Name:    Title:
Social Security #:       % of Ownership:
Home Address:         Floor/Suite/Apt:
City:   State:   Zip:     Phone:
E-mail:
Name:    Title:
Social Security #:       % of Ownership:
Home Address:         Floor/Suite/Apt:
City:   State:   Zip:     Phone:

I agree that by submitting this form, I, the undersigned individual, recognizing 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.
 
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