Credit Application

Thank you for allowing Citi Capital Group to provide your company with financing for your business equipment needs. Please fill out the information requested below. You will be contacted by a representative shortly.

E-Mail Address*

LESSEE INFORMATION

Full Legal Company Name*

Doing Business As (DBA)*

Address*

City*

State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip*

Company Phone*

Company Web Address*

Business Structure*
C CorporationGeneral PartnershipL.L.C.Limited PartnershipOtherPartnershipS CorporationSole Proprietor

Federal Tax ID*

Name & Title of Officer Signing Documents*

Description of Business*

Years in Business Under Current Ownership*

OFFICERS, PARTNERS or SHAREHOLDERS

Title*

First Name*

Middle Name*

Last Name*

Ownership Percentage*

SSN*

Birthdate*

House Number (home)*

Street Name (home)*

City (home)*

State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip*

Add OFFICERS, PARTNERS or SHAREHOLDERS

Add OFFICERS, PARTNERS or SHAREHOLDERS

VENDOR / EQUIPMENT INFORMATION

Amount*

Term Length*
24 months36 months48 months60 months72 months84 months

Equipment Description*

Is Equipment New or Used?
NewUsed

Vendor Name

Sales Rep

Phone

Attach Documents

Attach Document (.doc, .docx, .xls, .xlsx, .ppt, .pptx, .pdf)

Authorization*

By checking this box, each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Citi Capital Group or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purpose of update, renewal or extension of such credit and for reviewing or collecting the resulting account. A photostatic or facsimile copy of this authorization shall be as valid as the original.

Validation*

In order to submit this application, please provide the result of the following calculation: 7 + 4

Terms

Financing is for equipment that is to be used for business purposes, and is calculated using a two (2) payment advance: 1st and Last Payment, which is held as a Security Deposit. Quoted payments do not include Taxes, Maintenance, or Insurance. Quotes are subject to credit approval and may change without notice. Quotes are for good credit. Rates and structure may change by weaker credit. Terms for startup companies may structure differently depending on industry and strength of Lessee.