APPLICATION

Start Your Next Big Thing

Customer Information

Business Name*

DBA Name*

Street Address*

Street Address 2

City*

State*

Zip*

Business Phone*

Time in Business*

MonthsYears

Federal Tax ID

Business Type*

Equipment Information

Equipment Description*

Equipment Cost* $

Have you selected a Vendor for this equipment?

Yes

Owner / Guarantor Information

Full Name*

DOB*

Title*

Social Security Number*

Street Address*

Street Address 2

City*

State*

Zip*

Phone*

Email*

Add Personal Guarantor to Application?

Yes

* The undersigned applies for the lease indicated in this application. Everything stated in this application is correct. Prostar Funding Inc may retain the application whether or not the lease is approved. Prostar Funding and its Authorized Affiliates are authorized to check my credit and employment history for the purposes of determining my credit worthiness at the time of my application.

I Agree to adopt this typed representation of my name as my signature*

Signature*

ProStar Funding

APPLICATION

Start Your Next Big Thing

Customer Information

Equipment Information

Vendor Information

Owner / Guarantor Information

2nd Owner / Guarantor Information