Please Complete This Application as Fully as Possible

Business Name *

Business Structure *

• Corporation
• Partnership
• LLC
• LLP
• Sole Prop
• Cooperative

State or Province of Incorporation-Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Industry Code *-Select-Administration and Support of Waste Management and Remediation ServicesAccomodation and Food ServicesAgriculture, Forestry, Fishing and HuntingArts, Entertainment and RecereationConstructionEducational ServicesLandscapingFinance and InsuranceFitnessHealth Care and Social AssistanceInformationManagement of Companies and EnterprisesManufacturingMiningOther Services (except Public Administration)Professional, Scientific and Technical ServicesPublic AdministrationReal Estate Rental and LeasingRetail TradeTransportation and WarehousingUtilitiesWholesale Trade

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Business Address

City

State or Province-Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Zip or Postal Code

Business Phone

Annual Revenue *

Email *

Email

Confirm Email

Date business started *

Years in business under current ownership *

Federal Tax ID or Canadian BN *

Contact Name *

First

Last

Contact Cell Phone

Contact Email *

Email

Confirm Email

Guarantor(s)

Principal #1 Name *

First

Last

% Ownership *

Social Security Number or Social Insurance Number *

Principal #1 Home Address

City

State or Province- Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and Labrador.Northwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Zip or Postal Code

Principal #1 Phone

Principal #1 Cell Phone

Principal #1 Driver’s license number *

Drivers License State or Province-Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Date Of Birth *

Email *

Email

Confirm Email

Principal #2 Name

First

Last

% Ownership

Social Security Number or Social Insurance Number

Principal #2 Home Address

City

State or Province-Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Zip or Postal Code

Principal #2 Phone

Principal #2 Cell Phone

Driver’s license number

Drivers License State or Province

Date of Birth

Email

Email

Confirm Email

Dealer / Contractor Name

If no dealer, enter NONE.

Dealer Address

Dealer City

Dealer State or Province-Select-AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Delaer Zip or Postal Code

Dealer Contact

First

Last

Dealer Contact Phone

Dealer Contact Cell Phone

Dealer Email

Email

Confirm Email

Vessel Description

Builder / Manufacturer

Type of VesselTugBargeCrew BoatSupply BoatTanker BoatFishing VesselPatrol - Security VesselsPassenger VesselsCargo VesselsOther

Year, Model and LOA

Engine(s) Manufacturer and Horsepower

Number of Engines

• Single
• Twin
• Triple
• Quad

Fuel

• Gas
• Diesel

Boating Experience (Please describe other boats owned)

Total Cost

Preferred Finance Structure *

• Capital Lease
• Operating Lease
• EFA (Equipment Finance Agreement)
• Other (Please Specify Below)

Other Desired Finance Structure

Term Requested-Select-3 yr5 yr7 yr10 yr15 yr20 yr25 yr

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Notes

I (we) authorize WorkBoat Capital, its Assigns, and/or their Lenders to obtain information in connection with this application, including credit inquiries/reports, employment history and any other information necessary to evaluate credit. Upon request, I (we) will be informed as to whether or not a credit report was requested by WorkBoat Capital in conjunction with this application and if a report was requested. I (we) will be informed the name and the address of the consumer reporting agency that furnished the report. Furthermore, this application shall remain the property of WorkBoat Capital.

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