Equipment Finance Application

Business Info

Company Name

Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

E-mail *

Years in Business

Website

Number of Employees

Annual Sales

Federal Tax ID#

Type of Company

Number of Owners *

1 2 3 or more

Are you purchasing Equipment?

Yes No

Vendor Company Name

Vendor Email

Vendor Phone

Equipment Type

Year, Make, Model

Equipment Cost

*Optional* JupFin Sales Rep

COVID QUESTIONS

Given today's environment, we are asking a few questions to get a better understanding of your business and equipment needs. In order to process your application faster, please answer the below questions.

Why are you looking to purchase equipment at this time? Is it critical?

What is your COVID-19 action plan?

What are the short term and long term impacts of COVID-19 on the business?

Has your supply chain been impacted? Will it be impacted?

Principle 1

Full Legal Name *

First Name Last Name

SSN #

Date of Birth

mm/dd/yyyy

% of Ownership

ex. 100%

Title

Example: Owner, President, CEO, etc.

Mobile Phone

Area Code Phone Number

Email

example@example.com

Homeowner

Yes No

Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature Principle 1 *

Clear

DateTime

Principle 2

Full Name 2

First Name Last Name

SSN # 2

Date of Birth 2

mm/dd/yyyy

% of Ownership 2

ex. 100%

Title 2

Example: Owner, President, CEO, etc.

Mobile Phone 2

Area Code Phone Number

Email 2

example@example.com

Homeowner 2

Yes No

Home Address 2

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature Principle 2

Clear

DateTime

Principle 3

Full Name 3

First Name Last Name

SSN #3

Date of Birth 3

mm/dd/yyyy

% of Ownership 3

Title 3

Mobile Phone 3

Area Code Phone Number

Email 3

example@example.com

Homeowner 3

Yes No

Home Address 3

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature Principle 3

Clear

Please upload your Driver's License

Browse Files

DateTime

I agree that the information herein are true and correct. I also agree that by signing the box above, it is my digital signature for the application and all statements are true to be mine and only mine.

By clicking the Submit Application button, I hereby authorize Jupiter Financial Services, Inc., and its assigns and/or designees including banks, financial institutions, lenders etc. to make business and or personal credit inquiries as necessary throughout the term. I understand that this may include a personal credit bureau which will be used in the credit evaluation process. I also authorize Jupiter Financial, its designees or assigns to contact me via any means or media deemed necessary.

Date