Customer Information
Legal Name*
Franchise Store #*
DBA/Franchise*
DUNS/D&B #
Address*
Federal Tax ID #
City*
State*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Owner Name*
Zip*
Owner Cell
xxx-xxx-xxxx
Business Phone*
Owner Phone*
xxx-xxx-xxxx
Email*
Owner Fax
xxx-xxx-xxxx
Guarantor Information
(Please add a guarantor to ensure expedited processing)
Add a Guarantor
Remove Guarantor
Copy Contact Information from above
First Name*
Email
Last Name*
Phone
xxx-xxx-xxxx
Title
Cell Phone
xxx-xxx-xxxx
Address
Drivers License #
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UM
VI
UT
VT
VA
WA
WV
WI
WY
City
Birth Date
mm/dd/yyyy
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UM
VI
UT
VT
VA
WA
WV
WI
WY
Zip
SSN
xxx-xx-xxxx
Percent Ownership
US Citizen
Yes
No
Add Additional Guarantor
Remove Guarantor
First Name*
Email*
Last Name*
Phone*
xxx-xxx-xxxx
Title*
Cell Phone*
xxx-xxx-xxxx
Address
Drivers License #
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UM
VI
UT
VT
VA
WA
WV
WI
WY
City
Birth Date
mm/dd/yyyy
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UM
VI
UT
VT
VA
WA
WV
WI
WY
Zip
SSN
xxx-xx-xxxx
Percent Ownership
US Citizen
Yes
No
Equipment Information
Equipment List
(Add)
Add Equipment
Cancel
Add Equipment
Description*
Supplier
Model
# Of Units*
Unit Cost*
Other Cost
Total Cost
Desccription
Model
Quantity
Unit Cost
Other Cost
Total Cost
Savings
Description 0
Supplier
$0.00
$0.00
$0.00
Savings
Description 1
Supplier
$0.00
$0.00
$0.00
Savings
Description 2
Supplier
$0.00
$0.00
$0.00
Savings
Description 3
Supplier
$0.00
$0.00
$0.00
Savings
Description 4
Supplier
$0.00
$0.00
$0.00
Savings
Description 5
Supplier
$0.00
$0.00
$0.00
Savings
Description 6
Supplier
$0.00
$0.00
$0.00
Savings
Description 7
Supplier
$0.00
$0.00
$0.00
Savings
Description 8
Supplier
$0.00
$0.00
$0.00
Savings
Description 9
Supplier
$0.00
$0.00
$0.00
Savings
Sub Total:
Sales Tax:
+
55.55
Total Price:
No Equipment Added
Pricing
Financed Amount
Finance Type*
Other
The request is outside of the promotional program and may be subject to current competitive market rates. Please submit the application and we will contact you to discuss your options.
Monthly Payment
Documents
Please upload your quote or invoice for the equipment being financed
Billing Information
Billing Info
Same As Customer Address
Name*
Address*
City*
State*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip*
Comments
Comments
I certify that I have read and agree to the terms and conditions and certify that all personal and business information is true and correct. I understand that when clicking Submit Application button below this deems as an approved electronic authorization to process the credit information submitted. All information provided in this application are true and complete and are made for the purpose of obtaining credit. I authorize BTFG to share your application and related information with its lending partners in order to complete the processing of this application. You authorize BTFG and its lending partners to retain and rely on my application and to access my credit report in order to evaluate my credit application.