ETC

Company Information
Stage
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Sub Broker
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Company Legal Name - (Sole Proprietors list your name EXACTLY as it appear on your driver's license) *
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Company DBA Name (if applicable)
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Address
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Required
Street Address Required City Required State (2 letter abbreviation) Required
Postal / Zip Code

Country
Will equipment be shipped to/stored at the business location above? *
N/A

Yes
No
Ship to Address
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Required
Street Address Required City Required State (2 letter abbreviation) Required
Postal / Zip Code
Business Phone *
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Company Information
Federal Tax ID
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Years In Business (including as an independent contractor) *
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Business Structure *
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State of Incorporation (2 letter abbreviation)
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Website
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Upload Last 3 Bank Statements & Vendor Quotes (max 5 docs & 20MB can be uploaded. Others can be emailed to credit@quailcap.com)
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Upload file

Equipment Information
“EQUIPMENT TYPE. Please also indicate if it’s New, Used or Mixed” *
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Amount USD *
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Will this equipment be used for rental purposes? *
N/A

Yes
No
For documentation purposes can you please advise if this equipment will be used for rental purposes? If so, can you please clarify which rental type(s) below?
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1. True Rental - To clarify, a client comes in, picks the equipment up, operates it, and returns it when they are done. You rent the equipment to others where it will be fully out of the control of your staff. 1. True Rental - To clarify, a client comes in, picks the equipment up, operates it, and returns it when they are done. You rent the equipment to others where it will be fully out of the control of your staff.
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2. Rental Service Package - Your staff delivers and sets up the equipment, may operate it, but it's generally in your control. After use, your team tears it down, packs it up, and returns it to your facility or another location. 2. Rental Service Package - Your staff delivers and sets up the equipment, may operate it, but it's generally in your control. After use, your team tears it down, packs it up, and returns it to your facility or another location.
Vendor Sales Rep Name
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Signor Information
Signor Legal Name
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Required First Required Last
Home Address
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Street Address City State (2 letter abbreviation)
Postal / Zip Code

Country
Signor Business Title *
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Signor Email *
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Signor Cell Phone (for verbal authorization) *
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% Ownership *
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Social Security # (Soft Pull on your credit - if not available enter'000000000') *
N/A
Birthday (MM/DD/YYYY)
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U.S. Citizen *
N/A

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