Commercial Loan and Equipment Leasing Application

Click here to download and print forms
Fax your application to (336) 464-2910.

Lessee: Legal Company Name *
Physical address
City	State	Zip code
Contact name
Contact phone number	Contact email *
Nature of business
Name of bank
Bank contact name	Bank phone number
Tax exempt (Choose One)
1. Principle 1. Principle Title %of ownership
2. Principle 2. Principle Title %of ownership
Equipment
Delivery timeframe
Terms requested
By clicking "Apply" below I understand & authorize Burgess Funding Group and its assigns to make business/personal credit inquires as necessary throughout the lease. The information, which may include a personal credit bureau, will be used in the credit evaluation. * Required to submit this form

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