Equipment Leasing Application-4leasehelp

Secure Lease Application

Please complete our one-page application below. If you wish to Fax your application rather than submit it
on-line, click here to download a printable verion.

Primary Contact

Email Address

Company Information

Company Name
Street Address
City
State
Zip

Telephone
Fax
Time in business	years
Business Type
Federal Tax ID

Principal Owner Information

Principal 1 Name
Address
City
State
Zip
Telephone
Social Security #
Ownership %

Principal 2 Name
Address
City
State
Zip
Telephone
Social Security #
Ownership %

Bank References

Bank Name 1
Bank Account #
Bank Phone
Bank Contact

Bank Name 2
Bank Account #
Bank Phone
Bank Contact

Trade References

Trade Reference 1
Phone Number
Account #
Contact

Trade Reference 2
Phone Number
Account #
Contact

Vendor Information

Vendor Name
Vendor Phone
Vendor Contact
Vendor Email

Product Description
Retail Cost
Lease Term
New or Used	New Used

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I hereby authorize our banks, trades references and financial institutions to release credit information to lessor and further authorize lessor to obtian other credit information including D&B reports and credit bureau reports.