ICE Finance — Credit Application

Commercial Credit Application

Equipment Requested

Description of Equipment / Vehicle

Year

Make / Model

New or Used

Equipment Cost / Invoice Amount

Vendor / Dealer Name

Vendor Phone

Finance Type Requested:

Business Information

Legal Business Name

DBA (if applicable)

Business Address

City

State & Zip

Business Phone

Business Fax

Federal Tax ID (EIN)

Date Business Established

Type of Business

Number of Employees

Annual Revenue (approx.)

Bank Name

Business Structure:

Principal / Owner Information

Full Name

Title

Home Address

City

State & Zip

Home Phone

Cell Phone

Email Address

Social Security Number

Date of Birth

% Ownership

Second Principal / Owner (if applicable)

Full Name

Title

Home Phone

Email Address

Social Security Number

% Ownership

Authorization & Signature

By signing below, the applicant(s) authorize ICE Finance to obtain credit reports and verify all information provided. Applicant certifies that all information is true and complete. ICE Finance may share this application with funding sources for the purpose of obtaining financing.

Authorized Signature

Date

Print Name & Title

Date