Select your Account Executive:

Lessee's Legal Business Name:

Years Licensed:

Specialty:

Federal Tax ID:

# of Employees

Time in Business

Sole Proprietorship

Partnership

Corporation

L.L.C.

Billing Address

Phone

Fax

Equipment Location (if different)

Principals, Owners or Members

Principal, Owner or Member (1)

Title

SSN

% Ownership

Address

Phone

Email

Principal, Owner or Member (2)

Title

SSN

% Ownership

Address

Phone

Email

Have any of the above principals, owners, or members ever filed bankruptcy?    Yes     No

Vendor Information :

Equipment Description

How did you hear about Summit Commercial Finance?:

Other:

By checking this box, applicant certifies that the above completed information is correct. The above named individuals as representatives for the applicant authorizes Summit Commercial Finance Co. and assignees to check references, bank accounts and Principals/ and or Guarantors' personal credit profiles in considering this application and for the purpose of the update, renewal or extension of credit to the applicant. A fax or photocopy of this authorization shall be valid as the original.

By submitting this application, I also wish to continue to receive updates from Summit Commercial Finance regarding our account. Information should be sent to the fax and/or email address given for the account.

A Summit Commercial Fiannce Representative will contact you shortly.

If you would rather complete the application and fax to Summit, please download the PDF file.