Heartland Fabrication & Machine Inc.
1-800-422-2215

sales@heartlandfabandmachine.com

Equipment Financing Application

FED I.D. # (if applicable):
Legal Business Name:
Address:
City: State: Zip: County:
Phone:
 Fax:
 Mobile or Pager:
 E-mail:

Business Structure:

Years in Business:
Main Product/Service: Years Under Present Ownership:

Principals: Owners
Name and Title % Ownership Home Address & ZIP Social Security #
1.
2.
3.
4.

Equipment
DESCRIPTION OF EQUIPMENT:
   
Equipment Dealer Name: Phone:
Equipment Cost: $ Terms Requested (Mos): New Used
Bank Information
Current Business Checking Information (2 years or more history preferred)
Bank (A) Location: Phone:
Contact: Account#:  
Account Types:
Bank (B) Location: Phone:
Contact: Account#:  
Account Types:

 

Trade References
Please provide information about your suppliers, landlord, loans or leases. May not be applicable for newer businesses.
Company Name: Contact:
City & State: Phone:

Company Name: Contact:
City & State: Phone:

Company Name: Contact:
City & State: Phone:

 

By clicking the Submit button you authorize the release of any credit information from any source including credit bureau reporting agencies and financial institutions relating to loan, lease, checking, savings, investment and trade accounts to Gem Leasing, a Division of Gem Capital Corporation, and its affiliated funding sources. The undersigned requests that if a faxed form is needed, it be expedited as quickly as possible. The undersigned hereby represents that information set forth herein is correct and complete. A photo static copy or fax transmission of this application shall be as valid as the original version.

 

 

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Heartland Fabrication & Machine Inc.

 
 
P. O. Box 279
Lena, WI 54139
1-800-422-2215
sales@heartlandfabandmachine.com