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Business Information
Business Name
Business Description
Business Type Sole Prop Part
LLC Corp
State of Inc
Date of Inc
Address
City
State
Zip
Phone
Fax
Years in Business
Tax ID

Business Banking References
Bank
Phone
Account
Bank
Phone
Account

Trade References
Company
Phone
Account
Company
Phone
Account
Company
Phone
Account

Lease/Loan References
Company
Phone
Account
Phone
Account

Owner/Principal Information
Name of Signor
Title
Home Address
City
State
Zip
Home Phone
Social Security #
Name(s) of other owner/principal(s)
Social Security #
Home Address
City
State
Zip

Equipment Information
Type of Equipment
Approximate Cost $
Preferred Lease Term 12 24
36 48
60

Signature and Authorization
I authorize the Lessor to make whatever credit inquiries that it deems necessary in connection with this lease application.

I authorize any person or financial institution to complete and furnish to the Lessor any information that it may have or obtain in response to such credit inquiries.
I declare all information set forth in this lease application to be a true representation of the facts, and I acknowledge that any willful misrepresentation on this lease application could result in criminal action.

Date

Signed
____________________________

Title
____________________________


Complete the application and Fax it to :
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