First Western Equipment Finance - Credit Application

Legal Business Name*

Date*

Business Address*

City*

County*

State*

ZIP Code*

Contact Name*

Business Phone*

Cell Phone*

Fax*

Email*

Business Ownership*

Sole Proprietor Partnership Corporation

Business Start Date*

Type of Business*

Owner / Officers / Partners

This information may be used to check the personal credit of individuals listed.

Name

Social Security Number

Title

Ownership Percentage

Home Street Address

City

State

ZIP Code

Home Phone

Home Ownership

Own Rent

Birth Date

Driver's License Number

Name

Social Security Number

Title

Ownership Percentage

Home Street Address

City

State

ZIP Code

Home Phone

Home Ownership

Own Rent

Birth Date

Driver's License Number

Bank Information

Bank Name

City

State

Phone

Checking Account #

Date Opened

Terms and Conditions

I (we) certify that the above information is complete and correct and the equipment is being acquired for commercial and not consumer use.

I (we) authorize the bank listed above to provide credit information to First Western Equipment Finance. I (we) understand that First Western Equipment Finance may use the provided information to check personal credit of owners, officers or partners indicated above.

First Western Equipment Finance will notify the Equipment Seller of credit decision unless otherwise directed by the applicant. Please indicate method of notification: Equipment Seller Phone Fax Email

Financial statements may be required based on credit and/or transaction size.

When you apply for an account with us, we will ask for your name, address, date of birth and other information that will allow us to identify you. We will ask to see your driver’s license or other identifying documents.

I (we) agree to these terms and conditions*

Equipment Information

Equipment Seller*

Contact Name*

Phone

Fax

Equipment Description

Make*

Model

Type/Size

GW Capacity (trailers)

Sale Price (before tax)*

Term (months)*

Rate Factor Used

Promo Code