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1 BUSINESS

2 OWNERSHIP

3 EQUIPMENT

Principles, Owners or Members
Principal, Owner or Member*
First Last
Title*
SSN*
% Ownership*
Address*
Street Address City State ZIP Code
Phone*
Email*
Are there additional Principals, Owners or Members?*
- Yes
- No
Additional Principal, Owner or Member
First Last
Title
SSN
% Ownership
Address
Street Address City State ZIP Code
Phone
Email
Have any of the principals, owners, or members ever filed bankruptcy?*
- Yes
- No

Equipment Information
Equipment Vendor Company Name
Phone
Contact Name
Equipment Cost
Condition
- New
- Used
Equipment Description
Your Summit Finance Officer's Name
Form Validation*
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.
- Agree
Date
Date Format: MM slash DD slash YYYY
Time

: HH

MM

Questions about our programs?

Brian Jordan
Alliance Funding Group
bjordan@alliancefunding.com
Office: (714) 453-3647
Cell: (650) 575-5884

Contact Information