Application For Financing

Home » Medical Equipment Financing » Application For Financing

Application For Financing

Simply fill out the credit form below to get pre-approval for equipment leasing.

Step 1 of 3

Legal Company Name(Required)

DBA

Federal Tax ID(Required)

Type of Business

Business Phone(Required)

Business Fax

Email Of Applicant(Required)

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Description(Required)

Years In Business(Required)

Name Of Officer Signing Documents

First Last

Title Of Officer Signing Documents(Required)

Banking Information

Bank Name

Account Number(Required)

Ownership Information

Owner 1 Info(Required)

First Last

Title

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number(Required)

Ownership %(Required)

Owner 2 Info

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number

Ownership %

Owner 3 Info

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number

Ownership %

Owner 4 Info

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number

Ownership %

Equipment Information

Equipment Type(Required)

Equipment Conditon

New

Refurbished

Equipment Cost(Required)

Credit Release

I Agree To The Following(Required)

First ChoiI hereby authorize our banks, trades, and financial institutions to release credit information to Tempus Financial Group, Inc. and/or its assigns. The undersigned individual, who is either a corporate officer, partner, member, personal guarantor, or owner of the applicant also authorizes Tempus Financial Group, Inc. or its assigns to pull a personal credit profile from a national credit bureau on all owners/guarantors as part of its due diligence into the credit worthiness of the applicantce

Name

This field is for validation purposes and should be left unchanged.

Phone Number

Our Location

1-702-710-9344