Credit Application

Please either complete this online form or download the PRINT VERSION and fax it to 716-694-9304. 

LESSEES FULL COMPANY NAME
EQUIPMENT ADDRESS
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER
FAX NUMBER
CELL PHONE NUMBER
TYPE OF BUSINESS
DATE BUSINESS STARTED UNDER CURRENT PRESIDENT/OWNER
WEB SITE ADDRESS
EMAIL ADDRESS

BUSINESS:

(choose one)
CORPORATIONLIMITED LIABILITYPARTNERSHIPPROPRIETORSHIP

PERSONAL INFORMATION ON OWNER(S):
Name Name
Address Address
City City
State State
Zip Zip
% of Ownership & Title % of Ownership & Title

BUSINESS BANK INFORMATION:
Bank Name Bank Name
Phone # Phone #
Contact Contact

VENDOR & EQUIPMENT INFORMATION:

(WHO ARE YOU GETTING THE EQUIPMENT FROM)
Business Name
Contact
Phone #
Equipment Description
Equipment
NewUsed
Cost (without tax)
Term
24364860
Security Code...
Security Captcha
Type Code Above Into This Box

 

NOTICE TO ALL BUSINESS APPLICANTS: IF YOUR APPLICATION FOR BUSINESS CREDIT IS DENIED, YOU HAVE THE RIGHT TO A WRITTEN STATEMENT OF THE SPECIFIC REASONS FOR DENIAL. TO OBTAIN THE STATEMENT, PLEASE CONTACT FERNWOOD CAPITAL & LEASING, LLC WITHIN 60 DAYS FROM THE DATE YOU ARE NOTIFIED OF OUR DECISION. WE WILL SEND YOU A WRITTEN STATEMENT OF THE REASONS FOR THE DENIAL WITHIN 30 DAYS OF RECEIVING YOUR REQUEST. NOTICE: THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATION AGAINST CREDIT APPLICANTS ON THE BASIS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, SEX, AGE (PROVIDED THE APPLICANT HAS THE CAPACITY TO ENTER INTO A BINDING CONTRACT); BECAUSE, ALL OR PART OF THE APPLICANT'S INCOME DERIVES FROM ANY PUBLIC ASSISTANCE PROGRAM; OR BECAUSE THE APPLICANT HAS IN GOOD FAITH EXERCISED ANY RIGHT UNDER THE CONSUMER CREDIT PROTECTION ACT. THE FEDERAL AGENCY THAT ADMINISTERS COMPLIANCE WITH THIS LAW CONCERNING THIS CREDITOR IS THE FEDERAL TRADE COMMISSION, EQUAL OPPORTUNITY, WASHINGTON, D.C. To secure this lease, Lessee agrees to pay to Fernwood Capital the advance payment and/or security deposit amount along with a non-refundable documentation fee required at the time of lease signing. If for any reason this lease is not finalized, it is specifically agreed that Fernwood Capital may retain the advance payment and/or security deposit amount and such amount is fully earned by Fernwood Capital.

By Clicking on the SUBMIT button above, each owner listed above confirms, each individual as a principal of and/or guarantor for the Business and authorizes Fernwood Capital, its designees, assignees and potential assignees, to review his or her personal credit profile and other information as provided by national credit bureaus, banks and third parties, as Fernwood Capital in its sole discretion shall deem necessary. Such review shall be made for the purpose of considering this Application and for the purpose of any update, renewal, extension or future credit submissions for this Applicant or for the collection and review on any resulting accounts with Applicant. The online submission of this Authorization shall be deemed valid as the original.