Applying For
Lease/Finance
Working Capital
Both
Step 1: Company Information
Step 2: Customer Information
Step 3: Equipment Information
Step 1: Company Information
New Company
Existing Company
Legal Company Name
Operating Name (DBA)
Business Type
---
Incorporated
Limited Liability Company
Limited Liability Partnership
Partnership
Sole Proprietorship
Credit Union
Federal Organization
Non-Profit Organization
State/Provincial Organization
Unincorporated
Unknown
In Business Since
Physical Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Province of Incorporation
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Business Phone
Ext.
Business Fax
Email Address
Website
Average Annual Revenue
Average Bank Balance
Step 2: Customer Information
Principal 1
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Principal 2
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Principal 3
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Principal 4
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Principal 5
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Principal 6
Remove Principal
Add Principal
New Contact
Existing Contact
First Name
Last Name
Job Title
Percent of Ownership
Same as Business Addr.?
Yes
No
Home Address
City
Province
---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Yukon
Postal Code
Mobile Phone
Email Address
Social Insurance Number
Date of Birth
Home Ownership
Own
Rent
Value of Home
Mortgage Balance
Ever Declared Bankruptcy?
No
Yes
Outstanding Judgements or Legal Proceedings?
No
Yes
Step 3: Equipment Information
Equipment Description
Estimated Equipment Cost
Equipment Status
New
Used
Equipment Year
Working Capital Amount
Budgeted Monthly Payment
Time Frame
---
Immediate
Within 30 Days
30 - 90 Days
Not Sure
Preferred Term (months)
Initial Payment Available
Est. Initial Payment %
Reason for Equipment Acquisition
Comments
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Processing...
Thank you for submitting your application. We look forward to working with you. Please expect a sales executive to contact you shortly.
Lease Reference Number:
Working Capital Reference Number:
Attachments
Remove Attachment
Add Attachment
Attachment 1
Attachment 1 Type
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Applicant Photo ID
Invoice or Quote
Attachment 2
Attachment 2 Type
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Applicant Photo ID
Invoice or Quote
Attachment 3
Attachment 3 Type
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Applicant Photo ID
Invoice or Quote
Attachment 4
Attachment 4 Type
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Applicant Photo ID
Invoice or Quote
Attachment 5
Attachment 5 Type
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Applicant Photo ID
Invoice or Quote
Attachment 6
Attachment 6 Type
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Applicant Photo ID
Invoice or Quote
Attachment 7
Attachment 7 Type
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Applicant Photo ID
Invoice or Quote
Attachment 8
Attachment 8 Type
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Applicant Photo ID
Invoice or Quote
Attachment 9
Attachment 9 Type
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Applicant Photo ID
Invoice or Quote
Attachment 10
Attachment 10 Type
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Applicant Photo ID
Invoice or Quote
Attachment 11
Attachment 11 Type
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Applicant Photo ID
Invoice or Quote
Attachment 12
Attachment 12 Type
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Applicant Photo ID
Invoice or Quote
Attachment 13
Attachment 13 Type
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Applicant Photo ID
Invoice or Quote
Attachment 14
Attachment 14 Type
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Applicant Photo ID
Invoice or Quote
Attachment 15
Attachment 15 Type
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Applicant Photo ID
Invoice or Quote
Attachment 16
Attachment 16 Type
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Applicant Photo ID
Invoice or Quote
Attachment 17
Attachment 17 Type
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Applicant Photo ID
Invoice or Quote
Attachment 18
Attachment 18 Type
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Applicant Photo ID
Invoice or Quote
Attachment 19
Attachment 19 Type
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Applicant Photo ID
Invoice or Quote
Attachment 20
Attachment 20 Type
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Applicant Photo ID
Invoice or Quote
Next
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For questions about financing, contact:
Ryan Risling
Phone:
888-435-4171 x225
Email:
ryan@patronwest.com
For all other inquiries, contact:
Danny Brewer
, President
Phone:
519-212-1782
Email:
danny@dcbmachinery.ca
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