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OFF-LEASE INVENTORY

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Financing Services
• Asset and Collateral Based Lending
• Repossessed Equipment
• Equipment Leasing
• Accounts Receivable Financing
• Specialty Truck Financing
• Special Programs
• Church Financing Program
• Medical Working Capital Loans
• Debt Restructuring
• Business Acquisition Financing
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Commercial Financing Application

Business Information * Required Fields
* Company Name:
* Business Phone:
* Business Fax:
* Business Address:
* City:
* State:
* Zip Code:
* Federal I.D. No:
* Date of incorporation:
* Type of Incorporation/Ownership:
* Type of Business:
Alternate Phone Number:
* Amount Requested $$:
How did you hear about us?:
Owner 1 * Required
* Full Legal Name:	First: M.I. Last:
* Title:
* Ownership %:
* SSN Number:
Date of Birth:
Home Phone:
Cell Phone Number:
Alternate Phone Number:
* Email Address:
* Home Address:
* City:
* State:
* Zip Code:
Owner 2
Full Legal Name:	First: M.I. Last:
Title:
Ownership %:
SSN Number:
Date of Birth:
Home Phone:
Cell Phone:
Alternate Phone Number:
Email Address:
Home Address:
City:
State:
Zip Code:

* Please Describe what your Financial needs are:
Please be specific. (For example: Equipment year, make model, type and miles or hours.)
* Terms of Financing:
* Purchase Price:
* Vendor(s) Name(s):
* Phone:
* Contact:
* Has Any Owner/Officer filed Bankruptcy in the last 5 Years?	Yes No
* Do you have collateral that you would like to pledge? If so, please describe items with estimated value:	Yes No

BANKING INFORMATION
Name of Bank:
Contact:
Bank Phone Number:
Address:
City:
State:
ZIP Code:
First Account Number (savings, checking, other):
Second Account Number (savings, checking, other):
Balance/Value of Accounts:
MORTGAGE INFORMATION
Mortgage Holder or Landlord Name:
Account Number:
Full Address:
Phone:
Contact:

By checking this box, the Applicants represent and warrant that all credit and financial information submitted is true and correct and that Vitality Finance Group may obtain any credit information necessary pertaining to this application. Submitting this application is equivalent to a signature.