Beacon Funding Corporation

Equipment Financing Center

Quick Application

This application is secure

This is a secure application used for qualification purposes. We will not disclose any personal information to outside companies (Privacy Policy). Required fields*

Your Financing Consultant

Bob Dubow

P: 8478972491

bdubow@beaconfunding.com

Owner Information

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First Name*

Last Name*

Street Address Line 1*

Street Address Line 2

City*

State*

Zip*

Owner Phone*

Email Address*

Social Security Number*

% of Business Owned*

Business Information

Legal Business Name*

DBA

Business Start Date*

Legal Structure*

Same as Owner Address

Street Address Line 1*

Street Address Line 2

City*

State*

Zip*

Same as Owner Phone

Business Phone*

Agero # (Optional)

Equipment Information

Type of Equipment*

Equipment Cost*

Equipment Make*

Equipment Model*

Equipment Description

Terms & Conditions

The applicant(s) certify that all information contained in this application, and all attachments hereto, are true and complete to the best of the applicant(s) knowledge, and are made for the purpose of obtaining credit for business purposes, and not for personal or family use. The applicant(s) hereby authorizes Beacon Funding Corporation and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now, from time to time, and at any time in the future, as may be needed in the credit evaluation and review process and waives any right or claim the applicant(s) would otherwise have under the Fair Credit Reporting Act in absence of this continuing consent. The applicant(s) further authorizes any bank, financial institution or trade reference to release credit information on the applicant(s) account(s) to Beacon Funding Corporation and/or its assigns. If applicable, applicant hereby authorizes Agero to share with Beacon Funding pertinent relationship and activity information relating to applicant’s Agero relationship. The applicant(s) hereby authorizes Beacon Funding to request and obtain individual or business tax transcript(s) from the IRS via IRS Form 4506-T and confirms that all declarations made within the 4506-T "Signature of taxpayer(s)" section are true and accurate. An electronic, photocopy or facsimile copy of this authorization with a copied, electronic or facsimiled signature shall be deemed to be binding, valid, genuine and authentic as an original-signature document for all purposes. A non-refundable documentation fee will be required for the preparation and distribution of contract documents. In accordance with the credit authorization statement above and to complete your Beacon Funding Corporation Online Credit Application, please enter your last name and last name of co-owner (if applicable) in the fields provided below.

I have read and agreed the above Terms & Conditions

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Your Financing Consultant

Bob Dubow

P: 8478972491

bdubow@beaconfunding.com

Thank you!