Source: HDD Financing Application

As a service to our customers, Finco, Inc. offers assistance in obtaining suitable financing for your purchases with us. We are only able to offer this assistance to US customers at this time. If you would like us to assist you in an attempt to obtain financing, please take one of the following actions:

	Fill out the application information below. The information you provide will be forwarded to our financing partner FirstCorp® for further processing.
	E-mail our sales department, or call 800-654-3484 in the US, and we will be glad to assist you.
	E-mail Jeremy Morgenstern with FirstCorp® or call directly at 847-324-1556.

Please note that Finco, Inc. is not in the financing business. All financing assistance requests we receive are forwarded to FirstCorp® for their review. Any offer to finance will come directly from them, at their sole discretion, and is dependent on your credit worthiness as determined exclusively by them. Filling out this form and clicking the SEND APPLICATION button constitutes your acknowledgment and acceptance of these terms, and further indicates your permission for Finco, Inc. to forward this information to FirstCorp®.

We respect your privacy, and will not share this information with any persons or organizations without your permission. Please refer to our privacy policy for a complete disclosure of how we may use personal information we collect from you, or feel free to contact us with any privacy questions or concerns.

Please note that this information is being sent via e-mail, which is NOT a secure transmission method. If you have concerns about transmitting this information via e-mail, please feel free to print the PDF application or this form, fill it out, and mail or fax it to us.

* denotes required field

COMPANY INFORMATION
* LEGAL BUSINESS NAME:
* CONTACT NAME:
BUSINESS ADDRESS:
CITY:
STATE / PROVINCE:
ZIP CODE:
COUNTRY:
* TAX ID NUMBER:
* BUSINESS PHONE:
BUSINESS FAX:
* CONTACT E-MAIL:
YEARS IN BUSINESS:
TYPE OF BUSINESS:	Proprietorship Partnership Non-Profit Corp

BANK REFERENCE # 1
BANK:
PHONE:
CONTACT:
ACCOUNT #:
BANK REFERENCE #2
BANK:
PHONE:
CONTACT:
ACCOUNT #:

TRADE REFERENCE #1
COMPANY:
PHONE:
CONTACT:
ACCOUNT #:
TRADE REFERENCE #2
COMPANY:
PHONE:
CONTACT:
ACCOUNT #:
TRADE REFERENCE #3
COMPANY:
PHONE:
CONTACT:
ACCOUNT #:

OWNERSHIP & PRINCIPLE INFORMATION
SIGNOR'S NAME:
TITLE:
PERCENT OWNERSHIP:
HOME ADDRESS:
CITY:
STATE / PROVINCE:
POSTAL / ZIP CODE:
COUNTRY:
HOME PHONE:
SOCIAL SECURITY #:
2^nd OWNERSHIP INFORMATION
SIGNOR'S NAME:
TITLE:
PERCENT OWNERSHIP:
HOME ADDRESS:
CITY:
STATE / PROVINCE:
COUNTRY:
HOME PHONE:
SOCIAL SECURITY #:

LOAN/LEASE REQUIREMENT
EQUIPMENT DESCRIPTION:
AMOUNT REQUESTED:	(US Dollars)
TERM REQUESTED: (In Months)
PURCHASE OPTION:
COMMENTS:
Lender/Lessor is hereby authorized to obtain further information concerning my credit standing from any bureau or the references herein listed.