Sales & Service: 800-330-3867 Sales & Service: 800-330-3867 Sales & Service: 800-330-3867

Home
About
Products
Digitizing Service
Support
Training
Warranty
Financing
Learning Center
Contact

Finance Application

ADIA Capital has financed thousands of machines for MESA and has a great working knowledge of the equipment you are financing. Adia's niche approach ensures you are dealing with the BEST equipment suppliers in the apparel decorating industry.

This form will submit directly to Adia Capital, LLC. If you have any questions, please contact Adia Capital directly at 866-757-0244 (toll free).

WARNING: JAVASCRIPT DISABLED! This form requires Javascript to function properly. Please enable Javascript before continuing. Google offers simple instructions for enabling javascript in most popular browsers : http://www.google.com/support/bin/answer.py?answer=23852.You may also continue without javascript enabled, but please confirm that all required fields are completed before submitting this form, otherwise your data may be lost.

Please complete all required (*) information to submit the application. If you are unable to provide some of the required information, please enter an explanation, or type NA.

This form cannot be displayed on small screens. Please try again on a device with a larger screen, or call Adia Capital toll free at 866-757-0244 for assistance.

*Required information.

Vendor Information

Sales Representative:

Equipment Description:

Equipment Cost:

Please enter the total cost of the equipment.

Condition:

New
Used

Lease Term:

Monthly Payment Amount: $

Purchase Option:

FMV
1.00
10%
Other

Business Information

DBA (if any):

Company Name:

Business Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Please enter a valid email address.

Business Established:

Type of Business:

Non-Profit
C Corp
Proprietorship
Partnership
SUB "S" CORP
L.L.C.

Tax ID # :

Nature of Business:

Equipment Location:

Has the applicant or any guarantor ever had:

Repossession
Bankruptcy
Judgment
None

Information on Principals

Principal 1

Your Name:

Title:

Social Security Number #:

Address:

City:

State:

Zip:

Do you:

Rent
Own

Percentage of Ownership:

Place of Employment:

Home Phone:

Cell Phone:

Work Phone:

Email:

Please enter a valid email address.

Principal 2

Your Name:

Title:

Social Security Number #:

Address:

City:

State:

Zip:

Do you:

Rent
Own

Percentage of Ownership:

Place of Employment:

Home Phone:

Cell Phone:

Work Phone:

Email:

Please enter a valid email address.

I / We hereby authorize the release of any and all credit information to Adia Capital, LCC from the above listed references, and certify that all is true and correct to the best of my knowledge. The undersigned individual(s), recognizing that his/her/their individual credit histories may be a factor in the evaluation of undersigned, 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.

Please type I AGREE or I DISAGREE in the following box to acknowledge your authorization.