Application – Mechanical Capital Solutions

Credit Application Form

Credit Application Form for Equipment Leasing

Date(Required)

Credit Amount Requested(Required)

Dealer Name(Required)

Ownership Information

Please complete the below information for all officers, partners, members and owners.

Officers, Partners, Members and Owners Information

Name

Title

% Ownership

Home Address

Home Phone

Bank Reference

Name of Bank(Required)

Contact Name(Required)

Phone Number(Required)

Account Number(Required)

Type of Account(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Trade References (3 minimum)

Please list three significant business relationships

References(Required)

Name

Address

Phone #

Contact

Mortgage Holder/Landlord Information

Own or Rent(Required)

Do you rent or own premises that the business occupies?

Years at location(Required)

Please enter a number greater than or equal to 1.

Mortgage Holder/Landlord Name:(Required)

Contact person(Required)

Address(Required)

Phone(Required)

Applicant Name

Your Full Legal Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Files

Please add original quote from Dealer.

Upload Dealer Quote(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Credit Release Authorization

CREDIT RELEASE AUTHORIZATION(Required)

I agree, authorize, and accept.

CREDIT RELEASE AUTHORIZATION

I hereby certify that the information contained in this lease application is true and accurate and I hereby authorize our banks, trade references, and financial institutions the right to release credit information. 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.

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 is the Federal Trade Commission Equal Credit Opportunity, Washington, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Lessor set forth above within 60 days from the date you are notified or our decision. We will send you a written statement of reasons for the denial within 30 days for receiving your request for the statement.

Notice: To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify and record information that identifies each person (individuals or businesses) who opens an account. What this means for you: When you open an account or add any additional service, we will ask you for your name, address and taxpayer identification number that will allow us to identify you. We may also ask to see other identifying documents.

Signature

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