First Make a $100 processing fee and upload the screenshot

Type Of Application
—Please choose an option—CorporationSole Proprietorship

Business Name

Corporation name or DBA name

Partner incorporation
—Please choose an option—None1234

Time in Business
—Please choose an option—None1yrs2yrs3yrs4yrs6yrs7yrs8yrs9yrs10yrs

Federal Tax ID

Tax ID number or EIN Number

First Name

Middle Name

If any

Last Name

Social

[Ex- Keep in format like this: 123-45-6789]

DOB

Applicant's Date of Birth [Match with CDL]

CDL#

Commercial Driving License

Is Applicant Owner Operator?

[Ex: 1 year and 8 months to be written as 1.8 yrs]

Email Address

Main email address of the client

CDL Age

[Ex: 1 year and 8 months to be written as 1.8 yrs]

Address

[Ex: 123 Abc St. APT# A]

City

[Ex: Lathrop]

State

Use Abbreviation of the States

ZIP Code

Always 5 Digits

REFERENCES

(Not living with you. No business related references such as freight broker or employer)

Reference 1 Name

Reference 1 City, State

[Ex: Lathrop, CA]

Refrence 1 Phone#

Reference 1 Relationship
—Please choose an option—FriendRelative

Reference 2 Name

Reference 2 City, State

[Ex: Lathrop, CA]

Refrence 2 Phone#

Reference 2 Relationship
—Please choose an option—FriendRelative

Reference 3 Name

Reference 3 City, State

[Ex: Lathrop, CA]

Refrence 3 Phone#

Reference 3 Relationship
—Please choose an option—FriendRelative

Equipment Information

Make of the Equipment
—Please choose an option—FreightlinerKenworthVolvoPeterbiltUtilityWabashGreat DaneHyundaiOther

Model Of the Equipment

Type Full Form - T680, Cascadia, VNL 800 etc

Year Of the Equipment

[EX: 2022]

Price Of the Equipment

Full Purchase price of the equipment

Price Of the Equipment

Full Purchase price of the equipment

Is this Equipment Additional or Replacement?
—Please choose an option—AdditionalReplacement
Type : Additional if Buying first time or adding additional.

Fleet Size
—Please choose an option—012345678910
Total number of Truck & Trailers client own and is in his name.

Down Payment of the Equipment
—Please choose an option—10%20%30%40%
Have client fill out the maximum downpayment here.

Equipment Parking Yard Address

GVWR Of the Equipment

[EX: 52,000]

Engine Year Model

Engine Make Model

[EX: Cummins, Volvo, Detroit etc..]

Employer Information

Company Name

[EX: Swift Transportation]

Contact Name

Usually Dispatcher Contact name

Company Phone

Best contact of the Employer

The signer certifies that he/she is authorized to execute this Application for the named business (“Applicant”), and that all information and documents submitted, are true, correct, and complete. Applicant certifies that he/she has secured or applied for all applicable licenses or permits needed to conduct the named business. The signer authorizes Virsa Capital, Inc. and its partners to obtain consumer and/or business reports in their names as individuals at any time. The signer further agrees to notify Virsa Capital promptly of any material change in any such information. The signer authorizes Virsa Capital and its partners to contact references and request criminal record information from criminal justice agencies for the purpose of determining eligibility. The signer understands and agrees that this application is subject to final credit approval. The signer also agrees Virsa Capital can share information for marketing purposes with its partner companies and the applicant has the option to opt out from marketing anytime by contacting us at +1 516-859-6300
or send email: deals.aspirecapitals@gmail.com.

The signer/Applicant acknowledges that Virsa Capital is a finance broker who assists borrowers of equipment financing in applying for an equipment loan with various finance lenders. Virsa Capital shall be sharing the Applicant’s personal and financial information with these lenders to receive quotes and help originate the equipment financing. Applicant acknowledges that Virsa Capital shall be charging Applicant a fee as agreed in a separate agreement in addition to Virsa Capital receiving any referral fees, origination fees, and other related fees from their vendor(s)/ partner(s The signer/Applicant agrees that Virsa Capital or its agent(s) does not owe a general or special fiduciary duty to Applicant under this brokerage relationship.

The Applicant allows Aspire Capital to communicate via mobile phone texting

The Applicant allows Aspire Capital to share his/her CDL and equipment purchases order with our partnered insurance compnines

Full Name of the Applicant

First & Last Name

Date of the Appliation

Date

Signature of the Client