Vendor Services | Business Equipment Financing

Distributor Application

Company Information

Company Name *
Address *
State *
Phone *
Type of Equip. Sold *
Equipment Condition:
Fed Tax ID#*
# of employees
Date Business Started
Email Address *
Operate Out of Different Location?
Current Leasing Company:

City *
Zip *
Type of Business *	Corporation LLC Proprietorship Partnership Non-Profit
Fax
Website
Resale Certificate#:
Average Size Transaction	$
Annual Sales	$
Annual Lease Volume	$

Personal Information

First Name *
Last Name *
Title *

Home Address *
City *
State *
Zip *

Equipment Information

Description * (Maximum 255 characters)

Consent and Authorization

Consent and Authorization for Credit Report:

The undersigned Lessee (hereinafter "Lessee") expressly authorizes American Capital Group (hereinafter "ACG") to obtain, directly or through an agent or its assignees, the Lessee's credit, background, and financial responsibility reports ("Reports") from any appropriate Reporting Agency and understand that such Reports may be used by ACG in the determination of whether or not to enter into a lease with Lessee.  Lessee understands that such investigations may include seeking information as to the background, credit and financial responsibility of Lessee's officers and principals, or any of them.  Lessee understands and consents that its credit information may be transmitted via the Internet, that such information may be accessible by unintended 3rd parties, that it is being submitted at our own risk, and that Lessee waives any right to any punitive damages arising out of or associated with the transmission, interception, use or misuse of the application. Lessee may request the status of this application to be transmitted by electronic mail and Lessee expressly authorizes ACG or its nominee(s) to transmit such message to the electronic mail address, which Lessee may provide.   Lessee hereby consents to allowing ACG to obtain any and all Reports from any and all appropriate Reporting Agencies and agrees that such information maintained by such Reporting Agencies will be supplied to ACG and/or any other companies which subscribe to said services.  Lessee therefore authorizes the procurement of said Reports by ACG and, if Lessee enters into a lease agreement with ACG, Lessee understands that this authorization shall remain on file and shall serve as on-going authorization for ACG to procure additional Reports at any other time during the lease agreement.

I hereby AGREE to the Consent and Authorization for Credit Report above.*


First Name:
Last Name:
Company Name:
Phone Number:
Email Address:
Equipment:
Equipment Cost:
TIB Years:
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Distributor Application

NEED YOUR
EQUIPMENT FAST?

What is the best
way to finance
your equipment?

Thank you for the opportunity
to serve You

Thank you, we will get back to you soon!!

Distributor Application

NEED YOUR EQUIPMENT FAST?

What is the best way to finance your equipment?

Thank you for the opportunityto serve You

Thank you, we will get back to you soon!!

NEED YOUR
EQUIPMENT FAST?

What is the best
way to finance
your equipment?

Thank you for the opportunity
to serve You