Lease Application

Lessee

Company

DBA

Tax ID

Type of Business:   CorporationS-Corp LLC Partnership Sole Proprietorship

Street Address

City

State

Zip

Mailing Address

City

State

Zip

Equipment Location (Physical Address)

Contact Name(s)

Tel

Fax

Mobile

E-mail

CCB No

CDL No

Nature of Business

Business Start Date

Years Owned

 

Bank References

Trades

Bank

SUPPLIER 1

Branch

Telephone

Account No

Account No

Bank Telephone

SUPPLIER 2

Contact Person

Telephone

Account Type:

Savings

Checking

Other

Account No

Officers/Owners/Partners

 

Name 1

Name 2

Title

SSN

Title

SSN

Residence

Residence

City

State

Zip

City

State

Zip

Home Phone

%Owned

Home Phone

% Owned

Drivers License No

State

Drivers License No

State

Spouse

SSN

Spouse

SSN

Equipment Description

Qty New/Used Description Model No Price (W/o Tax)
$
$
$
Terms Requested:

Vendor Information

Company Name

Phone

Address

Fax

City 

State

Zip

Contact Person

By submitting this form, you agree that you are either a principle of the credit applicant or a personal guarantor of its obligations, and provide written instructions to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau.  Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account.  A photostat  or  facsimile copy of this authorization shall be valid as the original.  By signature above, I/we affirm my/our identify as the respective individual(s) identified in the above application.