Application Form

To ensure processing of this application, please make sure all fields are complete and accurate.

Please contact Kaleb Pritchett with any question at Kaleb@bluestreetcapital.com or (714)316-1592

Customer Information

Complete Legal Name of Business

Date Business Started

Federal Tax ID

Type of Business

Website

First Name

Last Name

Email Address

Phone Number

Has the business or any principal/owner ever declared bankruptcy?

YesNo

If so, Please Explain

Mailing Address of Business

City

State

Zip Code

Vendor/Equipment Information

Vendor Name

Type of Equipment

Equipment Location

Approximate Cost

Age of Equipment

NewUsed

Please attach equipment quote or invoice. if available

I Agree to Terms and Conditions

By signing below, the undersigned individual(s), who is either a principal of the credit applicant or a personal guarantor of its obligations, authorizes lessor and/or debtor and their affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or creditworthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. The undersigned also hereby authorizes our banks, trade references, and financial institutions the right to release credit information. In states where permissible, I/we hereby authorize the filing and recording of UCC financing Statements showing the Secured Party's interest in the equipment and grant the Secured Party the right to execute lessee's/debtors name thereto. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in this application.

Contact Information