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Documentation Request Form
1
Business
2
Signers
3
Funding Source/Terms
4
Sellers
5
Equipment
6
Documentation Details & Attachments
Application # (Lead ID)
Customer Legal Business Name
*
Should match Secretary of State
Best Phone # for Verbal D&A
*
Customer FEIN/SSN
*
Business Mailing Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Is the equipment location different from the mailing address?
*
No
Yes
Equipment Location Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Equipment Location County
*
How many individually named signers/PG's are there?
*
1
2
3
4
5 or More
Corp Only
Name of Signer/PG #1
*
Title of Signer/PG #1
*
CEO
CFO
Manager
Member
Other (Please Specify)
Owner
Partner
President
Secretary
Vice-President
Verify Signer/PG #1 Title
*
Address of Signer/PG #1
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Name of Signer/PG #2
*
Title of Signer/PG #2
*
Additional PG Only (Not an Officer)
CEO
CFO
Manager
Member
Other (Please Specify)
Owner
Partner
President
Secretary
Vice-President
Verify Signer/PG #2 Title
*
Address of Signer/PG #2
*
Same as PG #1
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Name of Signer/PG #3
*
Title of Signer/PG #3
*
Additional PG Only (Not an Officer)
CEO
CFO
Manager
Member
Other (Please Specify)
Owner
Partner
President
Secretary
Vice-President
Verify Signer/PG #3 Title
*
Address of Signer/PG #3
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Name of Signer/PG #4
*
Title of Signer/PG #4
*
Additional PG Only (Not an Officer)
CEO
CFO
Manager
Member
Other (Please Specify)
Owner
Partner
President
Secretary
Vice-President
Verify Signer/PG #4 Title
*
Address of Signer/PG #4
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Other PG's/Signers (5 or More)
*
List name, title, and address for each guarantor
Funding Source
*
360
Advantage
Amur
Black River
Blue Bridge
Bryn Mawr
BSB
Calfund
Cashmere Valley Bank
Centra (4 Hour Funding)
Columbia River Funding
Dakota
East Harbor
Financial Pacific
First Federal
Global
Kenco
Mark Capital
Marlin
Maxim
North Mill
Paradigm
Pawnee
Quality
RLC
Simmons
Slim Capital
SLS
Stearns
Targeted
Team Funding
TimePayment
Ultimate
Wells Fargo EF
Purchase Option
*
EFA
Lease - $1/out
Lease - 10%
Lease - FMV
Lease - Term Residual
Equipment Cost ($)
*
+ Financed Funding Source Fees ($)
*
+ Financed Sales Tax Amount ($)
*
Is there any down payment being made directly to the seller?
*
Please Confirm
No
Yes
- Down Payment to Dealer ($)
*
= Total Agreement Amount ($)
*
Equipment cost + sales tax + financed fees - down payment
Term Length
*
Confirm Term Length
72
60
55 + 5
54
48
44 + 4
42
36
33 + 3
30
24
22 + 2
18
12
Buy Rate (%) or Rate Factor (Decimal)
*
Points on Agreement (Decimal)
*
Sell Rate Factor (Decimal)
Gross Commission ($)
*
Monthly Payment Sold to Customer ($)
*
Include tax, if applicable
Username:
derek@americanEFS.com
Password:
Alf#208alf
Advance Payment Type
*
0
1
1 + SD
2
2 + SD
A Larger First Payment
Capital Cost Reduction to Lender
Down Payment to Dealer Only
Security Deposit Only
One in Advance
Two in Advance
Total Cap Cost Reduction to Lender Outside of TValue/Amortization Schedule ($)
*
Total Advance Payment on Contract ($)
*
Total Security Deposit ($)
*
Funding Source Documentation Fee ($)
*
+ Broker Documentation Fee ($)
*
= Total Documentation Fee ($)
*
= Total of Gross Commission + Broker Doc Fee ($)
*
Total Customer Invoice ($)
*
- Less Commitments Retained by Broker ($)
*
= Total Due With Documents ($)
*
Comments or Notes About Payments or Structure
How many dealers or sellers are receiving funding from this agreement?
*
1
2
3
4 or More
Sale Leaseback
Name - Dealer or Seller #1
*
Amount Due - Dealer or Seller #1 ($)
*
Prefunding Required? - Dealer or Seller #1
*
No
Yes, Other
Yes (50%)
Yes (100%)
Please Describe Prefunding Need - Dealer or Seller #1
*
Method of Payment - Dealer or Seller #1
*
ACH
Cashier's Check
Check (Overnight)
Check (Regular Mail)
Wire Transfer
Address - Dealer or Seller #1
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Name - Dealer or Seller #2
*
Amount Due - Dealer or Seller #2 ($)
*
Prefunding Required? - Dealer or Seller #2
*
No
Yes, Other
Yes (50%)
Yes (100%)
Please Describe Prefunding Need - Dealer or Seller #2
*
Method of Payment - Dealer or Seller #2
*
ACH
Cashier's Check
Check (Overnight)
Check (Regular Mail)
Wire Transfer
Address - Dealer or Seller #2
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Name - Dealer or Seller #3
*
Amount Due - Dealer or Seller #3 ($)
*
Prefunding Required? - Dealer or Seller #3
*
No
Yes, Other
Yes (50%)
Yes (100%)
Please Describe Prefunding Need - Dealer or Seller #3
*
Method of Payment - Dealer or Seller #3
*
ACH
Cashier's Check
Check (Overnight)
Check (Regular Mail)
Wire Transfer
Address - Dealer or Seller #3
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Additional Dealers or Sellers (4 or More)
*
Name, amount due, prefunding required, method of payment
Type of Sale
*
Auction Sale
Auction or Dealer AND PPS
Dealer/Vendor
Private Party Sale
Type of Equipment
*
Non-Titled Only
Non-Titled AND Titled
Titled Only
Who is Handling Title Transfer?
*
Please Confirm
Broker (Uncommon)
Dealer/Vendor
Funding Source
Age of Equipment
*
New
New AND Used
Used
Equipment Description
*
Is the customer pledging additional collateral?
*
No
Yes
Additional Collateral Description
*
Broker Company Name
*
Broker Rep Name
*
Broker Email Address
*
Best Phone # for Questions
*
Have the Equipment and Seller/Vendor Already Been Approved by the Funding Source?
*
Please Confirm
No
Yes
Type of Documents Preferred
*
Please Confirm
E-Signature Documents (if possible)
Print to Sign Documents
Email Address for E-Docs - PG #1
*
Email Address for E-Docs - PG #2
*
Email Address for E-Docs - PG #3
*
Email Address for E-Docs - PG #4
*
Email Address for E-Docs - PG #5
*
Request Insurance Quote from InstaCover?
*
Please Confirm
Yes
No
Customer Email Address for Insurance Quote
*
Approval
Pledged Collateral Documentation
Drop files here or
Commitment Deposit Documentation or Receipt
Condition Reports, Photos, Spec Sheets
*
Drop files here or
Dealer Invoice(s), Bills of Sale, and Payment/Wire Instructions
Drop files here or
Driver's License/ID Copies for Guarantors/Signers
Drop files here or
Other Pre-Documentation Contingencies & Supporting Docs
Drop files here or
Proof of Ownership by Private Seller
*
Drop files here or
Title Copies, Title Instructions, Tax Rate Treatment Info
*
Drop files here or
TValue or Amortization Schedule (PDF)