Amount Requested

Vendor

Who are you purchasing equipment from?

Business Information

Owner 1

Is there a second owner?*

YesNo

Your Financial Needs

Has any owner filed bankruptcy in the last 5 years?*

YesNo

Would you like to pledge collateral?

YesNo

Financial Documents (Optional)

• ✅ Last 3 months bank statements

• ✅ Tax returns (last 2 years)

• ✅ 1099 forms (if applicable)

• ✅ P&L / Financial statement

• ✅ Credit report

Signature

I agree to the terms and conditions.