- APEX Financial Services

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Vendor_CRM_Account_ID

Hidden

Vendor_CRM_Contact_ID

Full Legal Business Name(Required)

Doing Business as (DBA)

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Phone Number

Business Website

Business Structure(Required)

FEIN - Tax ID

Industry

Date Company Formed

Owned Since

Description of Business

Reason For Purchase

Equipment Cost(Required)

New or Used?

Equipment Description(Required)

Will the equipment be located somewhere other than the business address?

Location of Equipment(Required)

Street Address Address Line 2 City State ZIP Code

Who are you purchasing from?(Required)

Dealer or Vendor

Private Party

Not sure yet

Seller Details

Seller's Business Name(Required)

Seller's Contact Person(Required)

Seller's Phone(Required)

Seller's Email

Applicant 1(Required)

First Middle Last Suffix

Title 1

Applicant 1 Home Address same as Business Address(Required)

Address 1

Street Address Address Line 2 City State ZIP Code

Mobile Number 1(Required)

Email 1(Required)

Date of Birth 1

SSN 1

Do you Own or Rent your home 1

Own

Rent

Have you ever filed Bankruptcy 1

No

Yes

Ownership Percent 1

Please enter a number less than or equal to 100.

Applicant 2

First Middle Last Suffix

Title 2

Applicant 2 Home Address same as Business Address(Required)

Address 2

Street Address Address Line 2 City State ZIP Code

Mobile Number 2

Email 2

Date of Birth 2

SSN 2

Do you Own or Rent your home 2

Own

Rent

Have you ever filed Bankruptcy 2

No

Yes

Ownership Percent 2

Please enter a number less than or equal to 100.

Additional Owners?

Yes

No

Applicant 3

First Middle Last Suffix

Title 3

Applicant 3 Home Address same as Business Address(Required)

Address 3

Street Address Address Line 2 City State ZIP Code

Mobile Number 3

Email 3

Date of Birth 3

SSN 3

Do you Own or Rent your home 3

Own

Rent

Have you ever filed Bankruptcy 3

No

Yes

Ownership Percent 3

Please enter a number less than or equal to 100.

Consent(Required)

I accept the Terms and Conditions.

By checking this box, each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Apex Financial Services or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purpose of update, renewal or extension of such credit and for reviewing or collecting the resulting account. An electronic or fax copy of this authorization shall be as valid as the original. You also agree to receive SMS update notifications from Apex Financial Services pertaining to this transaction.

Credit Application

Seller Details