US Capital Corporation
2800 West Higgins
Hoffman Estates, IL 60169
(815) 477-1600
(815) 455-4991 FAX

Finance Application

Click here to Determine Which Application to Use
Click here to Download the Rapid Form Application
Click here to Download the Summary Form Application
Secure SSL Transaction
This is a secure online finance application. We take great care to protect the information you supply on this site by encrypting it. If you'd rather fax your application, click the download link above.
What type of company is this application for?

Borrower/Lessee
Company Name:
D/B/A:
(Doing Business As)
Address:
City, State & Zip:
Telephone:
xxx-xxx-xxxx
 
Contact Name:
Direct Line:
xxx-xxx-xxxx
 
e-Mail:  
Fax:
xxx-xxx-xxxx
 
Fed Tax ID:
xx-xxxxxxx
 
D&B #:
(Dun & Bradstreet)
State of Incorporation / Organization:
Website:
Business Description:
Time in Business (Years):
Type of Business:

 
Vendor
Company Name:
Address:
City, State & Zip:
Telephone:
xxx-xxx-xxxx
 
Fax:
xxx-xxx-xxxx
 
Contact:
e-Mail:  

Bank Reference
Principal Bank:
Account Number:
Telephone:
xxx-xxx-xxxx
 
Contact:

Additional Comments
Personal Information on Officers, Partners or Owners
Name:
Home Address:
City, State & Zip:
Telephone:
xxx-xxx-xxxx
 
Social Security #:
xxx-xx-xxxx
 
% Ownership:  
Name:
Home Address:
City, State & Zip:
Telephone:
xxx-xxx-xxxx
 
Social Security #:
xxx-xx-xxxx
 
% Ownership:  
Trade References
Company Name:
Telephone:
xxx-xxx-xxxx
 
Contact:
Company Name:
Telephone:
xxx-xxx-xxxx
 
Contact:
Schedule of Equipment/Software or Services Attachments
Address of Installation:

Description of Equipment to be Financed:

Value of Equipment to be Financed:

(Optional) Attach files containing equipment/software or services to be financed (word,excel, PDF, etc.)
Depending on the size of the uploads (10mb max), it might take several minutes to submit your application:

1.  2. 

Proposed Finance Terms

Number of Months
(Installment Loan or Lease):

Financing type:


If leasing, Lease Purchase Option $1 or FMV:
 

* Complete financial statements may be required for all transactions exceeding $100,000.

I hereby represent all information is true, correct and complete. By placing my/our full name and date of birth in the indicated boxes I/we affirm my/our signature to be acceptable as a written signature. I/we authorize the release of any credit information, business or personal to be released to the submitter, its assigns or the above named vendor. Submitter complies with section 326 of the US Patriot Act. This law mandates that submitter or its assigns request and verifies certain information about you and your company. A copy or fax of this authorization shall be valid as the original.

Electronic Signature #1: Date of Birth: Title: Date:
   
(Type Authorizing Officer Name) (MM/DD/YYYY) (MM/DD/YYYY)
 
Electronic Signature #2: Date of Birth: Title: Date:
(Type Authorizing Officer Name) (MM/DD/YYYY) (MM/DD/YYYY)

Have a question? Please call US Capital Support at 815-477-1600 x1363 or e-mail at apps@uscapcorp.com