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EQUIPMENT FINANCING

Diversified Lenders has been financing equipment for more than a quarter century. We have been through the ebb and flow of the economy and understand how to make it work for our customers. With our direct financing, we are able to give you optimum rates and terms and can help you determine the true value of equipment.

Company Information

Company Legal Name

DBA (if any)

DOT #

Phone #

Federal ID #

Entity Type

Ownership Information

Owner #1

First Name

Last Name

Ownership %

Email

Home Address
City
State
Zip
Mobile Phone
Social Security Number
Date of Birth
Place of Birth (State and Country)
Driver's License #
Issuing State
Expiration Date

Owner #2 (if ownership % for #1 is less than 100%)

First Name

Last Name

Ownership %

Email

Home Address
City
State
Zip
Mobile Phone
Social Security Number
Date of Birth
Place of Birth (State and Country)
Driver's License #
Issuing State
Expiration Date

Equipment

Year

Make

Model

Miles/hours

Purchase Price/Retail Value

Seller (if any)

Current value of all other equipment company owns

Amount owed on all other equipment company owns

Total of monthly payments on current equipment loans and leases

Have you ever filed for bankruptcy?

If Yes, when

Any State/Federal tax liens against company or principals of company

If Yes, how much

Any judgment against company or principals

If Yes, explain

 By checking the box, you agree to the terms below.


By executing this application, the company and each of the undersigned person(s) certifies to the following : The information set forth in this application and in the documents, schedules, reports, statements and/or other information provided to Diversified Transportation Finance, Inc. (DTF) with or pursuant to this application are full, true, correct and complete and accurately reflect such information on the date(s) thereof; that owners/officers that DTF deems necessary and appropriate; that DTF is authorized to execute in the name of the Business and the undersigned person(s) and file against the Business and the undersigned person(s) in favor of DTF financing statements with respect to the Business and undersigned person(s) assets and that DTF is authorized to inquire of , investigate, confirm and verify any information contained in this application in any documents, schedules , reports, statements and/or other information provided under or pursuant to this application or learned by DTF as part of its investigation and review and the subsequent maintenance and review of any account opened as a result of this application.

Authority: The undersigned hereby warrants that he/she is an authorized representative of the company and has the authority to sign this application on behalf of the Applicant. The undersigned understand and acknowledges that this authority will be relied upon by DTF for each and every instance DTF extends services to Applicant and that DTF would not extend services to Applicant in the absence of this authority.

- IMPORTANT INFORMATION AND PROCEDURES FOR OPENING A NEW ACCOUNT -
To help the government fight the funding of terrorism or money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account , we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.