APPLYING FOR

Lease/Finance Working Capital Both

1. Company Info

2. Customer Info

3. Equipment Info

Legal Company Name ? *

Operating Name (DBA)

Business Type *

Years In Business *

Nature of Business *

Average Annual Revenue *

Physical Address *

City *

State *

ZIP Code *

Business Phone *

Ext.

Business Fax

Federal Tax ID

Name *

Title *

% Ownership *

Home Address *

City *

State *

ZIP Code *

SSN

Date of Birth *

Home Phone *

Add a second principal / owner (optional)

Vendor Company Name *

Vendor Sales Contact

Vendor Phone

Vendor Address

City

State

ZIP Code

Budgeted Monthly Payment ($)

Equipment / Finance Amount ($) *

Equipment Type / Description *

Notes

Upload Documents

Applicant authorizes Anuva Capital and its designees to obtain personal credit reports, bank, and other credit information in connection with this application.

Principal 1 agrees to the credit authorization above. *

Signature (type name) *

Title *

Date *

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For questions regarding financing, contact:

Ivan Rosillo

Phone: 714-787-1336

Email: ivan@anuvacapital.com

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APPLYING FOR

Principal / Owner 2