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Equipment Credit Application

Borrower Company Information

Legal Company Name		DBA Name
Type of Business		Business Start Date
Annual Revenue		FEIN#
Company Street Address		City
State		Zipcode

Personal Information on Officers, Partner or Guarantor

Owner Name		Title
Social Security Number		Ownership %
Home Address		City
State		Zipcode
Business Phone		Email
Mobile Phone		Home Phone

Use of Funds & Desired Funding Amount

Overview
Desired Funding Amount		Date to take funds

Declaration

The above information, together with any accompanying financial statements, schedules, or other material is submitted for the purpose of obtaining credit and is warranted to be true, correct, and complete.

The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor, or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his / her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and he/she will hold Ameris Bank d/b/a Balboa Capital and its assigns, agents or nominees harmless from and against all claims, demands, losses and liabilities, suits and legal proceedings, and any and all related costs and expenses, including but not limited to attorney’s fees and costs, incurred as a result. The undersigned understands that such investigation may include seeking information as to the background credit and financial information of any of your officers and principals. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in a good-faith exercised any right under the Consumer Credit Protection Act.

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial.

To obtain the statement, please write to Ameris Bank d/b/a Balboa Capital Corp, 575 Anton Boulevard, 12th floor, Costa Mesa, California 92626, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving a request for the statement.

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Balboa Capital https://www.balboacapital.com

Timestamp

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November 9, 2020 10:45 am PDT

Equipment Credit Application Uploaded by Balboa Capital - marketing@balboacapital.com IP 12.232.63.141