EQUIPMENT FINANCING CENTER
POWERED BY FIVE POINT CAPITAL
All information is required.
Company Information
Company Name: Company Address:
City: State: Zip: Telephone:
Referring Vendor Name: DBA:
  
Fax: Time in Business: Federal Tax ID: Type of Business:  

Personal Information
First Name: Last Name: Title: Social Security Number:
Home Address: City: State: Zip:
Home Phone: Alternate Phone: Email Address: 100% Owner:
Yes No

Business Information
Bank Name: Account Number: Bank Phone:
Bank Address:

DECLARATION
I hereby certify (i) the information above is true and correct, (ii) you are hereby authorized to investigate all bank, credit and trade references, and said references are hereby authorized to release any requested information to you or your nominee, (iii) such authorization shall extend to obtaining personal credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit for reviewing or collecting the resulting the account, (iv) this information may be transmitted by us to you and by you to underwriter(s) for the purpose of granting one credit, either electronically or manually, and that by submitting this application, I take full responsibility for transmission thereof, (v) I am over 18 years of age, (vi) I acknowledge my rights under the Fair Credit Reporting Act, (vii) I consent to receive facsimiles and emails sent Five Point Capital and its affiliates for the purposes of transmitting account updates, requests for information and notices, and (viii) this request is for business and not for consumer purposes.

USE OF YOUR PERSONAL INFORMATION
Five Point Capital collects and uses your personal information to operate and improve its sites and deliver the services or carry out the transactions you have requested. We use the information we collect to provide the services you request, to inform you of other products or services offered by Five Point Capital and its affiliates, and to send you relevant information related to Five Point Capital services. We do not sell, rent, or lease our customer lists to third parties.

YES I AGREE THAT THE INFORMATION I AM SUBMITTING IS TRUE AND CORRECT AND AGREE WITH THE TERMS IN THE ABOVE DECLARATION.

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