Please complete all required (*) information to submit the leasing application.This is your form description.
Vendor Information
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| Vendor: |
(company you are purchasing equipment from)
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| Sales Representative: |
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| Equipment Description: |
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| Equipment Cost: $ |
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| Condition: |
New
Used
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| Lease Term: |
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| Monthly Payment: $ |
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| Purchase Option: |
FMV
1.00
10%
Other
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Business Information
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| DBA (if any): |
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| Company Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Phone: |
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| Fax: |
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| Email |
Must be a vaild email address
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| Date Business Established: |
(If new business, please note "start-up")
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| Type of Business: |
Non-Profit
L.L.C
C Corp
SUB "S" CORP
Proprietorship
Partnership
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| Tax ID: # |
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| Nature of Business: |
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| Equipment Location: |
(if different)
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| Has the applicant or any guarantor ever had: |
Repossession
Bankruptcy
Judgement
None
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Information on Principals
Principal 1
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| Your Name: * |
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| Prefix |
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| First * |
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| Last * |
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| Suffix |
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| Title: |
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| Social Security Number: # * |
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| Address: * |
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| City: * |
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| State: * |
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| Zip Code: * |
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| Do you: * |
Rent
Own
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| Percentage of Ownership: |
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| Place of Employment: |
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| Home Phone |
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| Cell Phone |
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| Work Phone |
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| Email * |
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Principal 2
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| Name |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Title: |
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| Social Security Number: # |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Do you: |
Rent
Own
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| Percentage of Ownership: |
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| Place of Employment: |
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| Home Phone |
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| Cell Phone |
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| Work Phone |
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| Email |
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Principal 3
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| Name |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Title: |
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| Social Security Number: # |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Do you: |
Rent
Own
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| Percentage of Ownership: |
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| Place of Employment: |
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| Home Phone: |
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| Cell Phone: |
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| Work Phone: |
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| Email: |
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Bank References
Reference 1
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| Name |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Phone |
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| Account Number: # |
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| Contact: |
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Reference 2
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| Name |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Phone |
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| Account Number: # |
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| Contact: |
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Personal References
(Closest relative not living with you)
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| Name: |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Phone: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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Personal Reference
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| Name |
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| Prefix |
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| First |
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| Last |
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| Suffix |
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| Phone |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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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.
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