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EQUIPMENT FUNDING LTD  PO BOX 985 * SCOTTSDALE, AZ 85252                                FINANCE APPLICATION 480 949 0710 TOLL FREE 800 445 8396 FAX 480 949 7012 ____________________________________________________________________________________________________________________________ Business Name                                                                                                                                                                                                        Date Est. ____________________________________________________________________________________________________________________________ Business Adress Street  / City. Stae                                                                                                                                                                        How long ____________________________________________________________________________________________________________________________ Line of Business / Phone Number ____________________________________________________________________________________________________________________________ Previous Business if less than 2 years ____________________________________________________________________________________________________________________________ Location of Equipment ____________________________________________________________________________________________________________________________ Ownership: Proprietorship ( ) Partnership ( ) Corporation ( ) Fed. ID.#_____________________________________________________________ State of Incorporation:______________________________________ ____________________________________________________________________________________________________________________________ Name of Principals/Title                             SS#                                                Home Address                                                          Phone 1 ___________________________________________________________________________________________________________________________ 2 ___________________________________________________________________________________________________________________________ 3 ___________________________________________________________________________________________________________________________ 4 ___________________________________________________________________________________________________________________________ Bank Reference Branch                               Phone #                              Officer                                                                                     Acct# 1.___________________________________________________________________________________________________________________________ 2.___________________________________________________________________________________________________________________________ 3.___________________________________________________________________________________________________________________________ Trade/Lease/Finance References                                            Phone#                     City/State              Contact                                    Acct# 1.___________________________________________________________________________________________________________________________ 2.___________________________________________________________________________________________________________________________ 3.___________________________________________________________________________________________________________________________ 4.___________________________________________________________________________________________________________________________ Supplier of Equipment          Adress                                                                 Contact                                                                                      Phone Number _____________________________________________________________________________________________________________________________ Cost of Equipment: _____________________________________________________________________________________________________________________________ Description of Equipment/ Delivery Date _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Term Request ________ Option Requested _______   _____________________________________________________________________________________________________________________________ By signing below,the undersigned individual who is either a principal of the credit applicant or a personal guarantorof its obligations, provides written instructions to Equipment Funding Ltd (EFL)or its designee, assignee or potential assigneee thereof authorizing review of his/her personal credit profile from the national credit bureaus. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purpose of update renewal or extension or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization should be valid as the original. By signature below, I/we affirm /my/our identity as the respective individual(s) identified in the above application. In addition I/We hereby authorize the bank, trade and financial institutions to releasecredit information to EFL and or its assigns. The uindersigned represents that all information provided in this application is tru and correct. Date _________Signature(s)/title ________________________________________________________________________________________________ Date _________Signature(s)/title_________________________________________________________________________________________________