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

John Wesolowski

P: 847.897.2486

JWesolowski@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*

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 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. An electronic, photocopy or facsimile copy of this authorization with a copied, electronic or facsimile signature shall be deemed to be binding, valid, genuine and authentic as an original-signature document for all purposes.

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Credit Disclosure Administrator, Beacon Funding  Corporation, 3400 Dundee Road, Suite 180, Northbrook, IL 60062, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derived from any public assistance program, or because the applicant has in good faith exercised any right under the consumer credit protection act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, 600 Pennsylvania Avenue NW, Washington, DC 20580. USA PATRIOT ACT NOTIFICATION – The following notification is being provided to you pursuant to Part 326 of the USA Patriot Act of 2001, 31 CFR 103.121(b)(5): IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, including any deposit account, loan, lease, or extension of credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

I have read and agreed the above Terms & Conditions

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Your Financing Consultant

John Wesolowski

P: 847.897.2486

JWesolowski@beaconfunding.com

Thank you!