Patty - Providence Capital Funding

Quote Form - Wade Shipman

Apply for an equipment lease and get a quick decision. No paperwork or collateral is necessary, and all credit scores will be considered. There is no obligation once your application is submitted.

Company Information
Company Name*
Business Address*
City*
State*
Zip Code*
Phone #*
Email Address
Business Description
Business Type
Years in Business
Federal Tax ID #
Equipment Info
Seller Company Name
Equipment Type
Equipment Cost
Term Desired
Officer Information
No. of Officers
Officer 1
First Name
Last Name
Home Address*
City*
State*
Zip Code*
Title
Ownership %
Social Security #
Officer 2
First Name
Last Name
Home Address*
City*
State*
Zip Code*
Title
Ownership %
Social Security #
Declaration
Consent*
I agree to the terms and conditions.
IMPORTANT— APPLICANT READ BEFORE SIGNING The undersigned represents that all information provided with this Application is true and correct and hereby authorizes Lessor/Secured
Party to obtain from third parties, including Applicant’s bank, information it deems necessary to arrive at a decision regarding this Application. By signing below, the undersigned individual(s) as principal of and/or guarantor for the applicant, authorizes Lessor/Secured Party, its designee, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering
this Application and for the purpose of update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. I authorize all deposit, borrowing, financial and trade information to be released to Lessor/Secured Party by telephone or fax. A photocopy or fax of this authorization shall be valid as the original. To help fight terrorism and money laundering, the information you provide may be verified to allow us to identify you.
Type Full Name*
Title*
Date*
Month
Day
Year

Quote Form - Wade Shipman

Company Information

Equipment Info

Officer Information

Officer 1

Officer 2

Declaration