Application – Mercury Capital

You can fill out the application online or download the PDF and email or fax it back to us.

Downloadable Application PDF

Enter as much information as you can since we rarely need to pull a hard inquiry and affect your credit.

Online Credit Application

Company Name*

DBA Name

Corporation Type

FEIN/Tax ID #

Company Address

Street City State Postal / Zip Code

Company Phone

Years in Business

Equipment Description and Cost:*

How many payments do you want to make?

Name of Bank

Checking Account #

Personal Information: Owners / Partners / Guarantors

First Name

Last Name

Title

SSN

Home Address

Street City State Postal / Zip Code

Personal Phone

% of Business Owned

For additional owners, fill out the information in the box below. Please provide name, phone number, social security number, and percent of business owned.

Additional Owner Information or Additional Comments’

Vendor Referral Information (If Applicable)

Vendor Name

Vendor Phone

Vendor Email

By clicking the submit button, the undersigned individual(s), who is either a principle credit applicant or a guarantor of it’s obligations, provides this written instruction to Mercury Equipment Finance Group, LLC d.b.a. Mercury Capital it’s nominees or assigns, authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in consideration of this application and subsequently for the purpose of update, renewal or the extension of such credit or additional credit and for reviewing and collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm our identity as the respective individuals in the related application.