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Company name

Fed Tax ID/EIN #

Business Address:

Street Address:

City:

State:

Zip Code:

Business Email

Business Phone Number

Years Under Current Ownership

Owner #1:

First name

Last name

Home Address:

Street Address:

City:

State:

Zip Code:

Title:

Mobile Phone

Social Security Number

Add Additional Owner or Co-Signer?

Funding Information:

I am applying for?

Equipment or Vehicle Financing

Working Capital Financing

Approximate Amount of Financing You Are Applying For:

Please tell us a little bit about your company, what you are looking to finance, and why you need the equipment or working capital.

File upload

Credit Authorization:

*BY SIGNING BELOW, EACH UNDERSIGNED INDIVIDUAL(S), WHO IS EITHER A PRINCIPAL OF THE CREDIT APPLICANT LISTED ABOVE OR A PERSONAL GUARANTOR OF ITS OBLIGATIONS, PROVIDES AUTHORIZATION TO COPLEY FUNDING OR ITS DESIGNEE (AND ANY ASSIGNEE OR POTENTIAL ASSIGNEE THEREOF) AUTHORIZING REVIEW OF HIS OR HER PERSONAL CREDIT PROFILE FROM A NATIONAL CREDIT BUREAU. SUCH AUTHORIZATION SHALL EXTEND TO OBTAINING A CREDIT PROFILE IN CONSIDERING THE APPLICATION OF THE CREDIT APPLICANT AND SUBSEQUENTLY FOR THE PURPOSE OF UPDATE, RENEWAL OR EXTENSION OF SUCH CREDIT AND FOR REVIEWING OR COLLECTING THE RESULTING ACCOUNT. A COPY, ELECTRONIC RECORD, OR FACSIMILE COPY OF THIS AUTHORIZATION SHALL BE AS VALID AS THE ORIGINAL.

Signature

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508-446-1385

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copleyfunding.com

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508.446.1385