Business Equipment Financing | Business Equipment Leasing

Broker Application

Company Information

Company Name *
DBA
Address *
State *
City *
Zip *
Phone *
Website
Associations *

Estimated Annual Funding *
Federal Tax ID *
Portal Email Login *
Portal Password *
Confirm Password *
Credit Email
Funding Email

Owner Information

First Name *
Last Name *
Home Street *
Home City *

Home State *
Home Zip *
Social Security Number*
Email*

Other Lender Information

Name *
Company *
Email *

Phone *
Estimated Annual Funding *
Length of Relationship *

Consent and Authorization

Consent and Authorization for Credit Report:

The undersigned broker (hereinafter "broker") expressly authorizes American Capital Group (hereinafter "ACG") to obtain, directly or through an agent or its assignees, the broker'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 an agreement with broker.  Broker understands that such investigations may include seeking information as to the background, credit and financial responsibility of broker's officers and principals, or any of them.  Broker 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 broker waives any right to any punitive damages arising out of or associated with the transmission, interception, use or misuse of the application. Broker may request the status of this application to be transmitted by electronic mail and Broker expressly authorizes ACG or its nominee(s) to transmit such message to the electronic mail address, which Broker may provide.   Broker 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.  Broker therefore authorizes the procurement of said Reports by ACG and, if broker enters into an agreement with ACG, broker 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 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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Broker Application

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Broker Application

Thank you for the opportunityto serve You

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

Thank you for the opportunity
to serve You