Maximum Capital Corporation || Equipment Leasing, Equipment Financing, Merchant Processing


Vendor Application
Company Information
Company Name
 
    		Email
Company Address


City


 State


 Zip
Signer

 		 Title
 Telephone #
 
Federal Tax ID

 		 Fax #
 
Type of Business
# of Employees
# of Years in Business
Information on Officers, Partners or Guarantors
Name


 Title


 SSN


 % Ownership
Home Address


 City
 State
 Zip
Home Phone #
      



Name


 Title


 SSN


 % Ownership
Home Address


 City
 State
 Zip
Home Phone #
      
Company Bank References
Name of Bank/Branch

How Long?


Checking Account #
Telephone #




 Contact Officer


  
Name of Bank/Branch

 		 How Long?
Checking Account #
Telephone #
 Contact Officer
  
Funding Sources
Name of Lendor



 		 City/State
 Telephone #
Contact Person
Name of Lendor
City/State
 Telephone #
Contact Person
Equipment Description
Type of Equipment Funded
  
 		 Avg. Equip. Cost
  
Avg. Deals / mo.     
  		 Target Market
Declaration
I/We understand that I/We may submit my application to Maximum Capital Corporation electronically by clicking "Submit Application" below, or I/We may submit the application by fax or mail. I/We authorize Maximum Capital Corporation to make such inquiries regarding the information furnished herein as may be required in connection with the application, or in the course of review of any credit extended in reliance on the application, such as obtaining individual credit bureau reports, Dun & Bradstreet business reports, and/or other credit reports/references. I/We represent that all information set forth in this application is a truthful and accurate representation of facts for the purpose of obtaining the lease financing requested by me/us. If I/We choose to submit this application electronically, I/We acknowledge that Maximum Capital Corporation is unable to ensure that the data cannot be intercepted by third parties. In submitting this application electronically I/We knowingly and voluntarily agree that Maximum Capital Corporation will not be held liable in any manner whatsoever should such interception occur. I/we understand that other financial information may be requested in connection with this lease application, and that this application is not an offer to extend credit.
Applicant
 Title
 Date

Applicant
 Title
 Date


Do you agree and accept terms?   I agree.   I do not agree.