Broker Enrollment Form

Company Name *

DBA (if applicable)

Company Website

Owner's Name *

Federal Tax ID (no dashes) *

Year Established *

# Company Employees *

# Sales Reps *

Company Street Address *

Company Address Line 2

Company City *

State/Province *

Zip Code *

Broker Information

Broker / First Name *

Broker / Last Name *

Title *

Company Phone *

Mobile Phone *

Company Fax

Email *

Social Security Number (no dashes) *

Date of Birth (MM/DD/YYYY) * +

Funding Source References

Funding Source Reference 1 *

Phone 1 *

Funding Source Reference 2

Phone 2

Funding Source Reference 3

Phone 3

Transaction Information

What is your ESTIMATED average ticket size? *

How many years of experience do you have in this industry? *

How many B-Credit lease apps do you come across monthly? *

How many C-Credit lease apps do you come across monthly? *

How many D-Credit lease apps do you come across monthly? *

Additional Information

Which type of industry(s) do you primarily lease equipment to? (check all that apply): *

Manufacturing	Service
Construction	Restaurants
Retail	Professional
Automotive	Other

How did you learn about TEAM? *

AACFB	NEFA
NACLB	Internet
Website	Trade Show
Training Course	Other

Current Memberships: *

AACFB	NEFA
NACLB	NONE

Are you able to pull credit reports? *

Yes

No

Have you ever been convicted of a crime? *

Yes

No

File Uploads

Broker Agreement *

Broker W9 Form *

Acceptance

Acceptance *

I (we) accept the following terms outlined below.

By checking the acceptance box, individual(s) (Brokers) provides instruction to TEAM Funding Solutions or its designee (and any nominee or potential assignee thereof) authorizing review of his/her personal consumer credit report from a consumer credit reporting agency. Such authorization shall extend to obtaining a consumer credit report in considering the application of the broker applicant and subsequently for the purpose of conducting background checks, updating, renewing or the extension of such credit and for reviewing and/or collecting the resulting account, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent. In addition to authorizing review of my/our consumer credit report from any consumer credit reporting agency, the undersigned also authorizes my/our financial institutions and creditors to release credit information required by TEAM Funding Solutions or its designee (and any assignee or potential assignee thereof). BY checking the acceptance box above, I/we affirm our identity as the respective individuals identified in the related application. The undersigned states that all of the statements and information in the application provided are true and complete.