Business Information

    Company Name*

    Company Type*
    LLCCorporationPartnershipSole Proprietor

    Billing Address*

    Equipment Address (if different)

    City*

    State*

    Zip*

    Phone*

    Email*

    Nature of Business*

    Year in Business*

    Select a Respresentative*

    Tax ID

    Principal Information

    First Name*

    Last Name*

    Title*

    Ownership %*

    Home Address*

    City*

    State*

    Zip*

    Social Security*

    Phone*

    Second Owner (if applicable)

    First Name

    Last Name

    Title

    Ownership %

    Home Address

    City

    State

    Zip

    Social Security

    Phone

    Equipment / Project

    Description

    Term (in months)
    1224364860

    Total Equipment Cost $

    Vendor/Supplier of Equipment

    Vendor Contact

    Vendor Phone

    Other Information

    Other information you would like us to know

    *Required Field


    Credit Authorization:
    By signing this application, this allows Patriot Financial LLC, a Pennsylvania Corporation and all of its lending partners authorization to pull credit for the above mentioned equipment purchase.

    Equal Credit Opportunity Act Notice
    If your application for business credit is denied, you have a right to a written statement of the specific reasons for the denial. To obtain the statement, please contact. Program Compliance Manager, at Patriot Financial, LLC within 60 days from the date you are notified of our decision. Our mailing address is: Patriot Financial, LLC, 407 West Lincoln Highway, Suite 300 Exton, PA 19341. Attn: Program Compliance Manager. Our telephone number is 866-633-6003.

    We will send you a written statement of reasons for denial within 30 days of receiving your request for the statement. The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, gender, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.

    The federal agency that administers compliance with this law concerning this creditor is the Consumer Financial Protection Bureau, 1700 G Street NW, Washington DC 20006. Applicant: Please retain for your records

    USA PATRIOT Act Notice
    To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person or entity opening an account or establishing a credit relationship with the financial institution. This requirement applies to Patriot Financial, LLC.

    What this means for you: If you are an individual, when you open an account or apply for credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may ask to see your driver’s license or other identifying documents. If you are a business or entity, we will ask for information about your entity, including its tax identification number, address, and documents evidencing legal incorporation, formation or existence. We may also request information about your owners, directors and executive officers.

    *Signature Required

    (866) 633-6003 (Office)

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