Applying For
Lease/Finance
Working Capital
Both
Step 1: Company Information
Step 2: Customer Information
Step 3: Equipment Information
Legal Company Name
DBA
Business Type
---
Incorporated
Limited Liability Corporation
Limited Liability Partnership
Partnership
Sole Proprietorship
Credit Union
Federal Organization
Non-Profit Organization
State/Provincial Organization
Unincorporated
Unknown
Years In Business
Physical Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Business Phone
Ext.
Business Fax
Email Address
Average Annual Revenue
Average Bank Balance
Federal Tax ID
Principal 1
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Principal 2
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Principal 3
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Principal 4
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Principal 5
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Principal 6
Remove Principal
Add Principal
First Name
Last Name
Title
Percent of Ownership
Home Address
City
State
---
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Email Address
Social Security Number
Equipment Description
Vendor Company Name
Vendor Contact Name
Vendor Contact Number
Estimated Equipment Cost
Working Capital Amount
Budgeted Monthly Payment
Time Frame
---
Immediate
Within 30 Days
30 - 90 Days
Not Sure
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Lease Reference Number:
Working Capital Reference Number:
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For questions about financing, contact
David Goldstein
Phone:
714-450-1026
Fax:
(888) 330-8617
Email:
dgoldstein@alliancefunds.com
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