Highland Capital Corporation
Online Quick Credit Application

Let HCC help you acquire the equipment and technologies you need to help your
business grow - Apply Now!

Welcome to HCC's Online Quick Credit Application.
To apply, simply fill out the following application, print it, and fax it to 877-526-4HCC
Please note that an asterisk (*) denotes a required field.
Company Information Business Type
* Company Name 
* Address 
* City 
* State 
* Zip 
* Phone 
Contact Person 
Fax 
E-mail 
Business Type 
Years in Business 
# of Employees 
Line of Credit Sought $ 
Equipment to be Acquired 
Equipment Supplier 

For Medical Profession Only:
License # 
Profession 
References
Principal Bank (Name/Branch) 
Account Number 
Phone 
Contact Person 
Primary Trade (name) 
Account Number 
Phone 
Contact Person 
Personal Information
Owners or Partners
1) Name 
Home Address 
City 
State 
Zip 
Email 
Social Security # 
2) Name 
Home Address 
City 
State 
Zip 
Email 
Social Security # 
3) Name 
Home Address 
City 
State 
Zip 
Email 
Social Security # 
4) Name 
Home Address 
City 
State 
Zip 
Email 
Social Security # 
Date of Application
* Applicant Name 
  (Signature if fax) 
* Title 
* Date 
Simply fill out the form, print it, and fax it to 877-526-4HCC
AUTHORIZATION: By completing, printing and faxing the above application, you certify that the information provided in this credit application is accurate and complete and you authorize Highland Capital Corporation, its successors and/or assigns to obtain information from the references listed and obtain a consumer credit report that will be ongoing and relate not only to the evaluation and/or extension of the business credit requested, but also for purposes of reviewing the account, increasing the credit line on the account (if applicable), taking collection action on the account and for any other legitimate purpose associated with the account as may be needed from time to time. The individual signing or submitting this application further waives any right or claim, which such individual would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent.

ECOA NOTICE (TO BE RETAINED BY APPLICANT): Your business credit application will be reviewed carefully and a decision will be rendered promptly. If your business credit application is denied you have the right to a written statement of the specific reasons for denial. To obtain a statement, please contact us within 60 days from the date that you are notified of our decision. We will send you a written statement of the reasons for denial within 30 days of your request. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided 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 our compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.
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Valley National Bank