Business
Information
Lease Term:
12 Mo. Lease
24 Mo. Lease
36 Mo. Lease
48 Mo. Lease
Full Legal Name
(Include DBA if applicable)
Tax Identification #
Billing Street Address
City
County
State
Zip
Equipment Location
(if different from above) (Street Address/City/County/State/Zip)
Contact Name and Title
Phone #
Business Description
Years in Business
Name
(Personal Guarantor/Principal/Partner/Officer)
Social Security #
Home Street Address
(Personal Guarantor/Principal/Partner/Officer)
"S" Corporation
Corporation
Proprietorship
Partnership
LLC
LLP
City/State/Zip
Phone #
(Net Worth Statements, 2 Years of Financial Statements
and 2 Years of Tax Returns may be necessary.)
Equipment
Information
Total Estimated
Equipment
Cash Price:
$
# of Advance
Payments:
Total Estimated
Lease Payment:
$
Equipment Description
Equipment Description
(Mfgr/Model)
End of Lease options:
FMV
Fixed %
Fixed $
Supplier Name(s)
Contact Name(s)
Phone #
Insurance
Agency Name
Agent Name
Phone #
Business Bank
Reference
Business Bank
Reference Name
Checking/Loan Account #
Phone #
Address
(City,State)
Account/Loan Officer
Personal Bank
Reference
Personal Bank
Reference Name
Checking/Savings Account #
Phone #
Address
(City,State)
Account/Loan Officer
Trade
Reference
Trade References
(Name/City/State/Telephone #)
1.
Phone #
2.
Phone #
3.
Phone #
Business
Purpose
The applicant (Lessee) certifies that it is applying for credit
for business purposes, and not for personal, family or home use.
Credit
Information
Release
I herby authorize any bank, financial institution or trade reference listed above to release appropriate credit information on the above account(s).
