Optamate Financing Application

"*" indicates required fields

Business Information

Proposal Amount

Legal Business Name*

Please attach a copy of your current business license

Business Phone Number*

Number of facilities*

Business Description*

Name of Primary Bank*

Please attach a voided check with the document uploads

Headquarters or Main Office*

Street Address City State ZIP Code

Years in Business*

Annual Revenue*

Business Structure*

Company Website*

Federal Tax ID #*

Preferred Lease Terms

Description of Equipment

Please Provide Details on your Equipment - Attach invoices below*

Required Attachments*

Drop files here or

Max. file size: 32 MB.

Please upload the following 1) 3-months bank statements or latest 3 years of financials, 2) Invoices for all equipment 3) voided company check

Signatures

Signature*

Name/Title*

Date*

Owner Information - *Large Corporations Can Skip The Owner Sections and Submit Your Request

Name

First Last

SSN #

% Ownership

Number of Owners

Cell Phone #

Email Address

Date of Birth

Home Address

Street Address City State ZIP Code

Owner #2

Add Owner #2 Information

Owner 2 Information

Name

First Last

Social Security Number

% Ownership

Number of Owners

Cell Phone #

Email Address

Date of Birth

Address

Street Address City State ZIP Code

Patriot Act Compliance Information

Applicants Drivers License Number

Issuing State

Expiration Date

Signature of Applicant

Date

Signature of Co-Applicant

Date

Comments

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