Municipal/Govt Application - Hampton Ridge Financial

Legal Name of Obligor*

Phone Number*

Federal Tax ID Number (EIN):*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does the obligor self-insure for property & liability insurance?*

Contact Person

Name

First Last

Phone

Email

Equipment/Project Information

Is the equipment new or used?*

Is this replacement equipment?*

Total Cost of Equipment/Project*

Describe the essential use of the equipment*

Vendor

Who are you buying the equipment from?

Declaration

Additional financial information may be requested if deemed necessary during credit review. By signing this application Obligor representative agrees to the following statement: “Everything stated in this application is correct to the best of my knowledge. I understand Obligee will retain this application whether or not it is approved. Obligor is authorized to verify any information on this application with an appropriate third party as necessary to complete the credit review process.” Please note that, depending on circumstances, we reserve the right to charge a reasonable fee to Obligor/broker, if this transaction is not funded. This fee is for expenses incurred and services performed related to the processing of the transaction. This fee will NOT be charged if the transaction is funded by Obligee.

I have read and agree to the Terms & Conditions