Equipment leasing 3

Step 1 of 2 - Finance Application

Personal information

Legal Name of Business*
Tax ID#*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Structure*
Date established
MM slash DD slash YYYY
Owner name*
Position*
Website
Home Phone
Cell Phone
Home Address
Street Address Address Line 2 City State ZIP Code
Own or rent home?
Current on mortgage?
- Yes
- No
Mortgage modification
- Yes
- No
How long at current address
Date of birth*
MM slash DD slash YYYY
Email*
Social security number*
Spouse Name

Bank reference

Name of bank*
Checking Account*
Checking Account Balance*
Contact
Phone
Loan Bal & #

Insurance Information

Name of Insurance Agent*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Policy #*
Expiration*

Work references

List your two largest customers or the hauling co/brokers you currently work for:
Name 1*
Contact*
Phone*
Name 2*
Contact*
Phone*

Equipment and vendor info

State of equipment to be financed*
Equipment/Vehicle to be financed:*
Price*
State of equipment to be financed
Equipment/Vehicle to be financed:
Price
Vendor/seller*
Contact*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code

Upload required documents

Please upload the following documents:
- Equipment specifications
- Description of Business (sales volume, business history, et al)
- 2 years Tax Returns (or accountant prepared financial statements)
- 3 months recent company bank statements
- Current Interim financial statements
- Personal Financial Statements (any owner 20% or more)
- Additional information if requested
all documents need to be uploaded to evaluate a deal.
required documents*
Drop files here or

Max. file size: 50 MB.

Assets

Cash on hands & in Banks
Savings Accounts
IRA or Other Retirement Account
Accounts & Notes Receivable
Life Insurance-Cash Surrender
Value Only - (Complete Section 8)
Stocks and Bonds
(Describe in Section 3)
Real Estate
(Describe in Section 4)
Automobile-Present Value
Other Personal Property
(Describe in Section 5)
Other Assets
(Describe in Section 5)
Total Assets

Liabilities

Accounts Payable
Notes Payable to Banks and Others
(Describe in Section 2)
Loan on Life Insurance
Mortgages on Real Estate
(Describe in Section 4)
Unpaid Taxes
(Describe in Section 6)
Other Liabilities
(Describe in Section 7)
Installment Account (Auto)
Monthly payments
Installment Account (other)
Monthly payments
Net worth
Total Liabilities

Section 1: Source of Income

Salary
Net investment income
Real estate income
Other income (describe below)
Describe other income
Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)

Section 2: Contingent Liabilities

As Endorser or Co-Maker
Legal Claims & Judgments
Provision for Federal Income Tax
Other Special Debt
List
Name and Address of Noteholder(s) Original Balance Current Balance Payment Amount Frequency (monthly,etc.) How Secured or Endorsed Type of Collateral

Section 3: Stocks and bonds

List Stocks and bonds
Number of shares Name of Securities Cost Market Value Quotation/Exchange Date of Quotation/Exchange Total Value

Section 4: Real Estate

Property A
Type of property
Date purchased
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Original cost
Present market value
Name Mortgage holder
Mortgage account number
Address Mortgage holder
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you want to declare another property?*
- Yes
- No
Property B
Type of property
Date purchased
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Original cost
Present market value
Name Mortgage holder
Mortgage account number
Address Mortgage holder
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you want to declare another property?*
- Yes
- No
Property C
Type of property
Date purchased
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Original cost
Present market value
Name Mortgage holder
Mortgage account number
Address Mortgage holder
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Section 5: Other assets

Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, describe delinquency

Section 6: Unpaid taxes

Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches

Section 7: Other Liabilities

Describe in detail

Section 8: Life Insurance Held

Give face amount and cash surrender value of policies - name of insurance company and beneficiaries

Any additional notes

Anything you would like to add?

Signatures

Consent*
I agree*
Applicant hereby authorizes Golden Dale Capital and its agents: (1) to obtain additional credit information about the company and its principals from banks, credit bureaus, and other creditors, and to make inquires in connection with this application, all of which are authorized to release such information concerning the applicant and/or the principal(s) as requested as part of a credit investigation, (2) to share credit information with Nations Equipment Finance affiliates and agents, and (3) that all the information in this application is true, complete and correct,. The person(s) signing below on behalf of applicant are authorized to make this application on its behalf and to agree to the foregoing. A photostatic copy of this authorization shall be as valid as the original.
Signature

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Phone

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

Name and Address of Noteholder(s)	Original Balance	Current Balance	Payment Amount	Frequency (monthly,etc.)	How Secured or Endorsed Type of Collateral

Number of shares	Name of Securities	Cost	Market Value Quotation/Exchange	Date of Quotation/Exchange	Total Value

Equipment leasing

Step 1 of 2 - Finance Application

Personal information

Bank reference

Insurance Information

Work references

Equipment and vendor info

Upload required documents

Assets

Liabilities

Section 1: Source of Income

Section 2: Contingent Liabilities

Section 3: Stocks and bonds

Section 4: Real Estate

Property A

Property B

Property C

Section 5: Other assets

Section 6: Unpaid taxes

Section 7: Other Liabilities

Section 8: Life Insurance Held

Any additional notes

Signatures