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Equipment Cost

fill in equipment cost w/o tax

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Payments above are estimates only
Payment may vary based on time in business and/or credit review
2 payments & a doc fee is required at lease signing
Equipment costs over $200,000, please call us for a quote


Mike Becker
Telephone: 888-241-8636 x12

Business Information

Business Name
Business Address
City State/Province Postal Code
Business Telephone Cell Phone #
Email Address
What year did you take ownership in the business
Percentage of Ownership & Title
Owners Name
Home Address
City State/Province Postal Code
Equipment Company Name you are purchasing equipment from

By Clicking on the 'Submit Application' button below, each undersigned individual, as a principal of and/or guarantor for the Applicant, authorizes Fernwood Capital, its designees, assignees and potential assignees, to review his or her personal credit profile and other information as provided by national credit bureas, banks and third parties, as Fernwood Capital in its sole discretionshall deem necessary. Such review shall be made for the purpose of considering this Applicant and for the purpose of any update, renewal or extension of credit to the Applicant or for the collection and review on any resulting accounts with Applicant. A fax or photcopy of this Authorization shall be valid as the original.

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