EQUIPMENT FINANCE GROUP

158 Las Banderas * Suite 255* Solana Beach * CA * 92075

PHONE 858.847.0000  FAX 858.847.0100

E-mail: sales@canfieldcapital.com  Toll Free 866.367.7393
LEGAL BUSINESS NAME PHONE
 DATE
STREET ADDRESS                                                                        CITY                           STATE                    ZIP
                       		FAX
MAILING ADDRESS IF DIFFERENT FROM ABOVE
 E-MAIL ADDRESS CELL PHONE
TYPE OF BUSINESS
 S.S. OR FEDERAL TAX NUMBER DATE ESTABLISHED
SOLE OWNER  PARTNERSHIP  CORPORATION
PRINCIPALS S.S.NO. TITLE HOME ADDRESS AND PHONE
BANK INFORMATION
NAME OF BUSINESS BANK ACCOUNT NUMBER PHONE BANK OFFICER
EXISTING LEASING OR LOANS
NAME OF INSTITUTION ACCOUNT NUMBER PHONE CONTACT
TRADE REFERENCES
BUSINESS NAME ACCOUNT NUMBER PHONE
 CONTACT
LANDLORD CONTACT PHONE
INSURANCE AGENT
 CONTACT
 PHONE
SUPPLIER OF EQUIPMENT
 CONTACT
 PHONE
TYPE OF EQUIPMENT
LEASE AMOUNT TERM PURCH.OPT.
FOR THE PURPOSE OF SECURING LEASE FINANCING, I AUTHORIZE ALL BANK AND TRADE INFORMATION TO BE RELEASED BY PHONE OR FAX TO CANFIELD CAPITAL
BUSINESS NAME SIGNATURE DATE

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