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Please complete the information below and click on "Submit for Approval".
Items with * are required. Other items are optional.   

Business Information    
Company Name:* 
Address Line 1:* 
City:* 
State/Province:*  Zip/Postal Code:* 
County:*  Federal Tax I.D. 
Phone #:*  Fax #: 
Date Established:
Enter as mm/dd/yy (Example: 02/01/04) 		   Business Type: 

Ownership Information:          
SSN (NO DASHES)* 
First, MI, Last:* 
Address Line 1:* 
City:* 
State/Province:*  Zip/Postal Code:* 
Home Phone:  Email: 
Title:*  Ownership %:* 
Cell Phone #: 
Date of Birth:   
Name As Listed on DL: 
 We will obtain a consumer credit report about each person identified as a guarantor in this lease application. By clicking "Yes" in the "Credit Release Obtained" box below, the user providing us with guarantor information represents that (a) each guarantor has authorized the user to supply us with such information in this application and (b) each guarantor understands that we will obtain a consumer credit report about the guarantor in connection with this application. 

Equipment Dealer Information    
Vendor Name: 
Address Line 1: 
City: 
State/Province:  Zip/Postal Code: 
Phone #:  Fax #: 

Equipment Information    
Estimated Invoice Amount: 
Equipment Description: 

Credit Release Authorization   
We hereby authorize the release of any and all credit information to ACG Equipment Finance and certify that all is true and correct to the best of my knowledge. The undersigned individual, recognizing that his or her individual credit history may be a factor in the evaluation of the credit application, hereby consents to and authorizes ACG Equipment Finance and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim that he/she would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent. A photocopy or facsimile copy of this authorization shall be valid as the original. 
I Agree to the above:*