Application | HPC Financial

Credit Application

Business & Contact Information

Applicant Legal Name *

DBA, if applicable

Business Structure *

Physical Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone Number *

Contact Name *

Contact Phone

Contact Email *

State of Organization *

Federal Tax ID Number (EIN) *

Years/Months in Business *

Industry *

Total Number of Employees *

Bank Information

Bank Name *

Bank Contact Name *

Bank Address *

Address Line 1

Address Line 2

City

State

Zip Code

Bank Phone Number *

Account Number *

Type of Account *

Owners/Guarantors

Owner/Guarantor Name *

First

Last

Title *

Ownership Percentage *

Date of Birth *

Social Security Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email *

Owner/Guarantor Name

First

Last

Title

Ownership Percentage

Date of Birth

Social Security Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Lease/Loan Requested

Request Range *

Amount of Request *

Term Requested *

Use of Funds *

Equipment Details *

Equipment Location *

Owner/Guarantor Name & Title *

I/We for ourselves and as an authorized signer of the applicant certify that everything stated in this application and on attachment, is correct. You may keep this application whether or not it is approved. By signing below, I authorized Highland Park Commercial Finance, its assignees or any other creditor to which Highland Park Commercial Finance refers this application for evaluation for financing to obtain and use credit reports, process this application, process any requested changes to my/our accounts, review performance of my/our accounts, and to collect any credit extended to me/us. It is understood that a photocopy of this form will also serve as authorization. I/We understand that I/we must update this credit information at your request and/or if my/our financial condition changes. I/We acknowledge that the credit being applied for will be used for business purposes. Applicant also authroizes Highland Park Commercial Financing or its assignees to file a UCC-1 Financing Statement in order to maintain a first priority security interest in the equipment and inventory. *

Owner/Guarantor Signature

Owner/Guarantor Name & Title

Owner/Guarantor Signature

Phone