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Secure Easy Equipment
Lease Application

* Denotes Required Field  
*Business Name:
*Business Address:
*Zip Code:
*Contact Name:
*Contact E-mail:

*Guarantor's Name:
*Guarantor's Address:
*Zip Code:
*Guarantor's Phone:
*Guarantor's SS#

Equipment Information

*Equipment Description:
*Amount of Acquisition
*Desired Term :
Current Amerifund Account Manager (If you spoke with one)
Miscellaneous information that you feel is important:

Mediatechnics does not finance equipment internally and instead uses the qualified services of Amerifund Financial for helping customers finance equipment. If your application for business credit is denied, you have the right to a written statement of the specific reason(s) for denial. To obtain the statement, please contact the issuing financial institution Amerifund, 9019 E. Bahia Dr., # 100, Scottsdale, AZ, 85260, (602) 607-1122 within 60 days from the date of their decision. They will send you a written statement of the reason(s) for the denial within 30 days of receiving your request for the statement.

NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act, the federal agency that administers compliance with this law concerning this credit is the Federal Deposit Insurance Corporation, 25 Ecker Street, Suite 2300, San Francisco, CA.

By clicking on the SUBMIT button below, I certify that the above given information given for the purpose of obtaining credit is true and correct. I authorize the person or firm to whom this application is made, any credit bureau or investigative agency employed by such person to investigate the references herein listed or other persons pertaining to my credit. I understand the terms of this instrument are not binding on Amerifund until accepted in writing by them.


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