Apply Now | Prime Capital

Applicant Information

Have You Received a Quote Previously?

Yes

Previous Quote Number(Required)

Full Legal Name(Required)

Operating As (trade name)

Select One(Required)

# of Employees

How long have you been in business?

Street Address(Required)

Apartment, Suite, etc.

City(Required)

ZIP / Postal Code(Required)

Province/State

Website(Required)

Email(Required)

Phone(Required)

Cell

Contact

Description (Include Year, Make, Model etc.)(Required)

Cost(Required)

Currency(Required)

Term (Months)(Required)

Vendor

Representative(Required)

Phone Number(Required)

Nature of Business(Required)

Reason for Equipment(Required)

PRINCIPAL/PERSONAL INFORMATION

Full Name(Required)

Date of Birth(Required)

SIN #(Required)

Homeowner?(Required)

Address(Required)

Street Address Address Line 2 City Postal Code

Province(Required)

How Long?(Required)

Own/Rent(Required)

Value(Required)

Mtg. Balance(Required)

Phone(Required)

Previous Employment(Required)

How Long?(Required)

Bankruptcy?(Required)

When?(Required)

Bank(Required)

Branch(Required)

Account #(Required)

The undersigned certifies the above information to be true and correct. By signing below, I consent and authorize the following entities: Prime Capital Group Inc., Xpedite Leasing Inc., and 941315 Alberta Ltd., (collectively known as Prime Capital Group) and its representatives, and any potential credit grantor assignee, at any time to obtain on an on-going basis, verify use, communicate with and disclose to third parties (including credit reporting agencies, credit exchanges, leasing brokers, on an on-going basis) any of my credit, financial, and personal information that Prime or its agents or affiliates deems necessary to complete, service or enforce any lease, ancillary deed or transaction, including but not limited to assignments and securitizations. We acknowledge that you or your financing partners may transfer and store information to jurisdictions where you or your financing partners do business. As a result, information may be accessible to regulatory authorities in accordance with the laws of these jurisdictions.

You authorize us to collect, hold, exchange and disclose your personal information as requested in order to administer your contract & determine your insurance eligibility as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. If you would like to review your own personal information, correct or revise existing information, have any questions, concerns or comments regarding its application please fax 1-780-437-7268 (Attn: Privacy Office) or mail #129, 625 Parsons Road SW Edmonton AB T6X 0N9 Attn: Privacy Office.

EQUIPMENT TO BE LEASED

Description (Include Year, Make, Model etc.) *

Cost *

Currency *

Term (Months) *

Vendor

Representative *

Phone Number *

APPLICANT INFORMATION

Full Legal Name *

Operating As (trade name)

Select One *

# of Employees

How long have you been in business?

Street Address *

Apartment, suite, etc

City *

ZIP / Postal Code *

Province/State

Website *

Email Address *

Phone *

Cell

Contact

Nature of Business *

Reason for Equipment *

PRINCIPAL/PERSONAL INFORMATION

Full Name

Date of Birth *

SIN #

Street Address

Apartment, suite, etc

City

ZIP / Postal Code

Province/State

How Long?

Own/Rent?

Value

Mtg. Balance

Home Phone

Previous Employment

How Long?

Bankruptcy?

When?

Bank *

Branch *

How Long? *

Account #

You authorize us to collect, hold, exchange and disclose your personal information as requested in order to administer your contract & determine your insurance eligibility as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. If you would like to review your own personal information, correct or revise existing information, have any questions, concerns or comments regarding its application please fax 1-780-437-7268 (Attn: Privacy Office) or mail #129, 625 Parsons Road SW Edmonton AB T6X 0N9 Attn: Privacy Office.

Electronic Acknowledgment (Applicant) *I, the Applicant, certify the above to be correct and I authorize Prime Capital Group to process my information.

Electronic Acknowledgment (Company Principal) *I, the Company Principal, certify the above to be correct and I authorize Prime Capital Group to process my information.

Reviews

We respond in four hours or less.
Get in touch today!

Contact Info

Reviews

We respond in four hours or less. Get in touch today!

Want to Grow your Business?

Send us a Message

We respond in four hours or less.
Get in touch today!