Equipment Financing Application What Is Your Full Name?* First Stage or Business Name Last Please include your Stage Name Example: Jonny JR Smith or Jonny's Pro AudioWhat Is Your Home Or Business Address?* STREET ADDRESS ADDRESS LINE 2 CITY AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon PROVINCE POSTALCODE When Is Your Birthday?*MM-DD-YYYYWhat Is Your Email Address?* What Is The Product Name or Number?*Example: Pioneer Speakeers XYZWhat Is The Best Phone Number To Call?*What Is The Intended Use For This Equipment?*Entertainment CompanyArtistEducationJust For FunPlease choose one of the selections from the drop-down menu.What Is The Best Time To Call You?*Select OneBetween 9:00 and 11:45 AMBetween 12:00 and 4:45 PMBetween 5:00 and 9:00 PMPlease choose your ideal call-window from the drop-down menu.What Is The Best Day To Call You?*MondayTuesdayWednesdayThursdayFridayWhat Is The Name Of Your Employer?*What Is Your Weekly Income?*Under $250Between $300-$500Between $500-$1000Over $1000How Long Have You Worked For Your Employer?*Less than 3 monthsBetween 6-12 monthsOver 12 monthsPlease Choose The Amount Of Funding You Need*$300.00-$499.00 (Rookie) APT Fee - $10.30$500.00-$2,500.00 (Starter) APT Fee - $59.30$2,501-$4,999.00 (Pro)* APT Fee $109.30PLEASE NOTE: The PRO Tier is reserved for Benjamin Verde Affiliates and Certified/Accredited Industry Professionals. Please Email support@benjaminverde.com for more information.Do You Want To Appy For a Verdified Grant?*Yes, I am a Member and agree to the additional charge of $5.00- $10.00No Thank YouYou will be charged an additional $5.00 to APT feeHow Did You Hear About Benjamin Verde?*Play De RecordArtist MemberSearch Engine (Google, Yahoo, Bing)Industry Professional (Word Of Mouth)Please let us know the name of the company or person that told you about Benjamin Verde. We would love to thank them.What Is Your Reason For Applying For This Equipment Financing?Brand BuilderAudio ProductionOnline RadioVideosOpen BoxHow Much Are You Investing In The Project?$0.00-$99.00$100.00-$499.00$500.00-$1000.00Ober $1000.00Images of CollateralAccepted file types: jpeg, jpg.Terms and Conditions* I Accept the Terms and Conditions Equipment Finance Agreement* I Accept the Assigned Equipment Finance Agreement CAPTCHAEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
