* Indicates a Required Field

Company Name*

DBA

Street Address*

City*

State*

Zip*

Phone*

Fax*

Website

Contact Name*

Email Address*

FED ID*

Organization Type*
Sole PropCCorpSCorpLLPLLC

State of Incorporation*

Date Established*

Years in Business (Present Ownership)*

Nature of Business*

Equipment Location if Different

Number of Employees*

Annual Sales*

Equipment to be Financed (Make and Model)*

Amount of Equipment*

Equipment to be Financed (Make and Model)

Amount of Equipment

Intentionally Left Blank

Term Options*
Thirty-SixFourty-EightSixtyOther

Finance Structure*
FMV10% Buy Out$1 OutLoan

Payment Target*

Name (Personal Guarantor/Principle/Partner/Officer) (1)*

Title*

Percent Owned*

Social Security*

Home Address*

City*

State*

Zip*

Date of Birth (mm/dd/yyyy)*

Name (Personal Guarantor/Principle/Partner/Officer) (2)

Title

Percent Owned

Social Security

Home Address

City

State

Zip

Date of Birth (mm/dd/yyyy)

By submitting this Application, the undersigned warrants that the applicant and each individual listed as a principal, partner, owner, guarantor or obligor consent, authorize and warrant as follows: (a) Working Ox Capital, LLC. and its assignees, designees, funding source or finance source ("WOC") may obtain commercial and consumer credit reports, investigate references and statements, and make other credit inquiries about the applicant and all such individuals, and anybody contacted in connection therewith may release any credit and financial information; (b) WOC and its affiliates may share with one another financial, credit and other information about the applicant and such individuals and use shared information to market to the applicant and the individuals; (c) the information on or accompanying this Application is true and complete, and the undersigned will notify WOC of any material change in any information; (d) this Application is submitted in connection with financing solely for business and commercial purposes and NOT for personal, family or household purposes; (e) the applicant, if an individual, is a citizen or lawful permanent resident of the United States; and (f) this Application will apply to any future request for additional financing and all notices, disclosures, consents and warranties shall be deemed repeated for each future request, unless the applicant submits a new written application. WOC does not make offers or commitments to extend credit except in final signed documents and, in limited circumstances, in and pursuant to the terms and conditions of written commitment letters. Term sheets, proposal letters, approval letters and the like are not commitment letters.
READ CAREFULLY BEFORE SUBMITTING THIS APPLICATION: We recommend that you print the Application, sign it below and fax or mail it to us at the address set forth above. If you send this Application by unencrypted and non-secure e-mail, the contents including non-public information may be at risk, and we are not responsible for the security of the contents or for any theft or loss of data during e-mail transmission. If you decide to assume the risk of submitting this Application by e-mail, enter your name as authorized agent below. By entering your name and submitting this Application to us, you agree that this Application is an electronic record executed by you using your electronic signature.

Signature (Personal Guarantor/Principle/Partner/Officer) (1)*

Signature (Personal Guarantor/Principle/Partner/Officer) (2)

EQUAL CREDIT OPPORTUNITY ACT. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact our Customer Service Manager, 907 US Highway 301 South, Tampa, Florida 33619 (813-865-0194) within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, 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 Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3450, Houston, Texas 77010-9050.