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Equipment Loan Express Application

Please fill in the information below. Information is required unless noted as optional. When finished, click "Submit Request” at the bottom of the page. 

All fields marked with * are required.

Personal Information

(as listed on driver's license)

 

Practice information

(Legal business name as registered with the Secretary of State; if sole prop or IC, type your name.)

 
Business Info

Co Signer Information

Would you like to add a cosigner? *

Cosigner Info
 
 

Equipment & Vendor Information
 

Have you selected a vendor? (Optional)

Vendor

Is there another vendor you are working with? *

Vendor

Are you working with more than 2 vendors? *


Financing Options You're Interested In

Payment Plan You're Interested In:(Number of months)(Optional)

Interested in 90 Day Payment Deferral? (Optional)

Do you have an invoice or financial document(s) you'd like to provide at this time? (Optional)

Documents
 

Comments

Documents
If you have any documents you would like to send us, you can upload them securely to: https://secure.ncmic.com/fileupload/equipmentfinance/ or email them to: equipmentfinance@ncmic.com.

Authorization and Disclosure

I hereby authorize the release of business and/or personal credit information to NCMIC Finance Corporation (NCMIC), its affiliates or assignees (1) from any source including credit bureau reporting agencies and my bank for the purpose of extending credit, and (2) to any credit reporting agency. I also hereby authorize NCMIC to order a credit report in connection with the administration, review, or collection of my account and in connection with offering additional products and services to me. Additionally if my application is not approved by NCMIC, I hereby authorize the release of my application without notice, to any other potential lending sources not related to NCMIC Finance Corporation for consideration of approval of credit. I hereby represent all information is true, correct and complete.  A photo static, facsimile, or other electronic copy of this authorization shall be valid as the original. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or a part of the applicant’s income derives from any public assistance programs, or because the applicant has in good faith exercised any rights under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. To help the Government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. This means that when you apply for credit or open an account with NCMIC we will ask for your name, address, date of birth, social security number, and other information that will allow NCMIC to identify you.  We may also require that you furnish NCMIC with a copy of your Driver’s License or other identifying documents.  Consult your attorney or financial advisor for specific legal and/or tax advice before entering into any type of financing arrangement, and for information on tax deduction eligibility and procedures.  NCMIC AND THE EQUIPMENT VENDOR AND/OR BROKER YOU SELECT ARE SEPARATE COMPANIES, ARE NOT AGENTS OF ONE ANOTHER, AND HAVE NO AUTHORITY TO BIND ONE ANOTHER TO FINANCIAL OR OTHER CONTRACTUAL OBLIGATIONS.

* I have read the Authorization and Disclosure and:


Apply for a Loan Today

Equipment Loan     Working Capital Loan

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