Credit Application

Legal Business Name

Type of Business⠀

Time in Business *

Tax I.D. Number

Business Address (include Suite or Apt #)

Main Phone Number⠀

Cell Phone Number

Email Address *

Web Address

Legal Name of Owner (as it appears on driver's license) *

Home Address (include Suite or Apt #)

Social Security Number⠀

Percentage of Ownership

Name of Co-Owner (if applicable) (as it appears on driver's license)

Home Address (include Suite or Apt #)

Social Security Number⠀

Percentage of Ownership

Partners Capital Sales Rep⠀

Vendor/Dealer Name

Equipment Description & Cost

Term(s) Requested (months)

Term *

The undersigned represents that this application is for credit for business purposes only and all information provided with this Application is true and correct, and hereby authorizes Equipment Leasing Group of America, LLC and its designee, assigns or potential assigns and its and their affiliates or any lending source to whom this application is submitted (collectively, "Creditors") to obtain from credit bureaus and other third parties, and share, information any of them deems necessary to arrive at a decision regarding this Application, including credit and criminal background checks. By signing below, the applicant and undersigned individual(s) as principal of and/or guarantor for the applicant, authorizes all such Creditors to review and share its/his/her personal credit profile provided by a national credit bureau in considering this Application and for the purpose of update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. Additionally, this authorization permits Creditors to share and exchange information and to request, obtain and review bank, financial or other information from past, present or potential Creditors. I authorize all deposit, borrowing, financial and trade information to be released by telephone or fax. A photocopy or fax of this authorization shall be valid as the original. To help fight terrorism and money laundering, Federal Law requires banks to verify the information you provide, which may include driver's license or other documents, to identify you. Adverse Action/ECOA. If this application for business credit is denied, you have a right to a written statement of the specific reasons for the denial. To obtain the statement, please contact our customer service department at Equipment Leasing Group of America, LLC within 60 days from the date you are notified of our decision. Our mailing address is 211 Waukegan Road, Suite 100, Northfield, IL 60093-2755. We will send you a written statement of reasons for denial within 30 days of receiving your request for the statement. The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, gender, 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 us is Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580.

I agree to the terms and conditions specified above.

By signing below, you understand that you are providing 'written instructions' under the Fair Credit Reporting Act authorizing the credit grantor to obtain information from your personal credit profile or other information from a consumer reporting agency. You authorize this credit guarantor to obtain such information solely to apply for credit.

Signature of Applicant *

Date *