Financing Application for Curbside Upfitters

Company Legal Name *

County Where Property Will Be Located

Address *

City *

State *

Zip *

Phone Number *

Date Established *

Nature of Business *

Business Type *

Fed ID#

State of Incorporation *

Principal Information

click the add button to enter additional Principals

Principal's Name *

Position *

% Of Ownership *

Cell Phone *

Home Address *

City *

State *

Zip *

Type of Ownership

Own

Rent

How Long

Social Sec #

Birth Date

Name of Spouse

Email Address *

Add Remove

Bank Reference(s)

click the add button to enter additional references

Name of Bank *

Phone Number

Person to Contact

Checking Account #

Savings Account #

Loan Account #

Add Remove

Loan/Lease Reference(s)

click the add button to enter additional references

Current Loan/Lease Obligation

Name of Co. or Bank

Phone Number

Account #

Add Remove

Do you rent your office space?

Yes

Lease Expiration

Number of Sq. Ft.

Vendor Information

Supplier/Dealer Name

Madison Capital Contact

City and State

Phone Number

QTY

Condition *

New

Used

Equipment to be Leased *

Term Desired

Price *

(without tax)

Additional Equipment/Vehicle Credit

I may need additional credit for equipment/vehicles in the next 6 months

Yes

For

$25,000

$50,000

$100,000

OtherOther

Release

To whom it may concern:

This will be your authority and my request for you to release to Madison Capital, LLC and/or its assignees, any information they may request concerning credit standing with your company and/or money on deposit. I hereby further authorize Madison Capital, llc and/or its assignees, to obtain any available personal credit bureau reports, as well as bank and trade references, and utilize photocopies of this release in conjunction with the credit application process.

For *

Company Name

By *

Name of Officer

Title *

Signature *

Clear

Signature

Date *

Madison Capital Financing Application for Curbside Upfitters

Principal Information

Bank Reference(s)

Loan/Lease Reference(s)

Vendor Information

Additional Equipment/Vehicle Credit

Release