Leasing Application

Please complete all required (*) information to submit the leasing application.

Vendor Information
  Vendor :   (company you are purchasing equipment from)
  Sales Representative:  
  Equipment Description:  
  Equipment Cost: $
  Condition:   New Used
  Lease Term:  
  Monthly Payment: $
  Purchase Option:   FMV 1.00 10% Other
 

Business Information
  DBA (if any):  
  Company Name:  
  Address:  
  City:  
  State:  
  Zip:  
  Phone:  
  Fax:  
  Email:  
Must be a vaild email address
* Date Business Established:   (If new business, please note “start-up”)
  Type of Business:  
Non-Profit C Corp
Proprietorship Partnership
SUB "S" CORP L.L.C
  Tax ID: #
  Nature of Business:  
  Equipment Location: (if different)  
  Has the applicant or any guarantor ever had:  
Repossession Bankruptcy
Judgement 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:  
 

Principal 2
  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:  
 

Principal 3
  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:  
 

Bank References

Reference 1
  Name:  
  Phone Number:  
  Account Number: #
  Contact:  
 

Reference 2
  Name:  
  Phone Number:  
  Account Number: #
  Contact:  
 

Personal References

Closest relative not living with you
  Name:  
  Phone Number:  
  Address:  
 

Personal Reference
  Name:  
  Phone Number:  
  Address:  
 
The applicant(s) certifies that all information contained in this application, and all attachments hereto, are true and complete to the best of the applicant(s) knowledge, and are made for the purpose of obtaining credit for business purposes, and not for personal or family use. The applicant(s) hereby authorize us and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now, from time to time, and at any time in the future, as may be needed in the credit evaluation and review process and waives any right or claim the applicant(s) would otherwise have under the Fair Credit Reporting Act in absence of this continuing consent. The applicant(s) further authorize any bank, financial institution or trade reference to release credit information on the applicant(s) account(s) ACL. and/or its assigns. An electronic, photocopy or facsimile copy of this authorization with a copied, electronic or facsimile signature shall be deemed to be binding, valid, genuine and authentic as an original-signature document for all purposes. A non-refundable documentation fee will be required for the preparation and distribution of lease documents.

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