Secured On-Line Financing Application

American Capital Corp
For Assistance Call: 800-585-7012 Ext–123
apps@americancapcorp.com

Company Information
Full Legal Business Name:
Business Entity Structure:
Business Street Address:
City:
State:
Zip:
Location of Equipment (if different than above):
Telephone:
Nature of Business:
Time in Business:

Equipment to Be Financed (Dealer and Equipment Information)


Vendor Company Name:
Vendor Address:
Vendor Phone Number:
Vendor Contact Person:
Amount To Be Financed:
Equipment Description:

New or Used:

Personal Information for all Owners, Officers and Guarantors

Full Legal Name:
Home Address / City / State / Zip:
SSN:
Title:
Email Address:
Cell Number:

Full Legal Name:
Home Address / City / State / Zip:
SSN:
Title:
Email Address:
Cell Number:
Credit Authorization:
Credit Authorization: I/We hereby authorize American Capital Corp, its designee, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of updating, renewing, extending additional credit or the collection of any late account. I/We hereby authorize our references to release all credit information and I/We represent and warrent that the information submitted herein is true, complete and accurate. A facsimile, electronic or other copy of this authorization shall be as valid as the original