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Product Interest Equipment FinanceWorking Capital

Amount Requested (numerical values only, no symbols or letters)

Company Name

DBA

Address (Include city, state & zip)

Business Phone

Business State of Incorporation

Federal Tax ID #

Time in Business in years under current ownership (numerical values only, no symbols or letters)

Annual Revenue

# of Business Owners

Primary Owner Legal First Name

Primary Owner Legal Last Name

Primary Owner Title

Primary Owner % Owned (*All owners need to be disclosed; numerical values only, no symbols or letters)

Primary Owner Social Security # (no dashes, numbers only)

Primary Owner Home Address

City

State

Zip Code

Primary Owner Email

Primary Owner Home/Cell Phone

Secondary Owner Full Name

Secondary Owner Title

Secondary Owner % Owned

Secondary Owner Home Address (Include city, state & zip)

Secondary Owner Cell Phone

Secondary Owner Social Security #

Secondary Owner Email

Additional Comments

Comments

By clicking "Submit Application" I authorize Innovative Lease Services, Inc. to perform a soft inquiry. The undersigned individual who is either a principal, a personal guarantor or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents and authorizes Innovative Lease Services, Inc. or its designee the use of a consumer credit report on the undersigned, from time to time as may be needed. The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Innovative Lease Services, Inc. (“ILS”) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify ILS of any change in such information or financial condition, (3) Applicant authorizes ILS to disclose all information and documents that ILS may obtain including credit reports to other persons or entities (collectively, “Assignees”) (4) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.

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FINANCING APPLICATION

Primo Espresso Company has partnered with Innovative Lease Services to provide you with financing options to lease or buy equipment with low monthly payments.