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

Dan Harris

914 A Street, #200

Tacoma, WA 98402

303.800.1059 (direct)

800.930.0570 (toll free)

800.821.5903 (fax)

dan@breweryfinance.com

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Business Information

Company Legal Name

Doing business as (DBA)

Company Phone #

Company Fax #

Website

Company Address

Company Address Line 1

Company Address Line 2

City

State

Zip Code

Business Structure

Date Company Formed

Federal Tax ID #

Business Description/Other Comments

Ownership/Management Information (all ownership with 20% or greater)

Title

First Name

Middle Name

Last Name

Work Phone #

Mobile Phone #

Residence Phone #

E-mail

Social Security #

Ownership % (rounded-no decimal-no % sign)

Residence Address

Street Address

City

State

Zip Code

Finance Details

Amount (xx,xxx)

Is equipment new or used?

Estimated Delivery Date

Vendor Company Name

Equipment Description

Authorization

By checking this box, each individual, who is either a principal of the credit applicant listed above or a personal guarantor of its obligations, provides written instruction to Brewery Finance Corp. or its designee (and any assignee or potential assignee thereof) to begin processing the Lease Application. After clicking “submit” below and sending the information to our secure servers you will be prompted to download a Credit Release form. We will need this form completed, signed, and either emailed or faxed back to us in order to complete your Lease Application in a timely manner. We look forward to providing you with a timely response to your financing request.

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Contact Information