EQUIPMENT LEASE CREDIT APPLICATION

All shaded areas are required fields.

Equipment Information (include quantity, make and model):
Equipment Description:
Total Equipment Cost ($):
Lessee Information
Company Name
Contact:
Street Address1:
Street Address2:
City:
County:
State:
Zip:
Phone:
Fax:
Contact E-Mail Address:
Federal Tax ID#:
Years in Business:
Nature of Business:
Business Type:
Bank Information
Name of Bank 1:		Bank Officer:
Phone #:		Deposit/Check Acct:
Officer/Owner Information (Owner #1)
Name:		% of Ownership:
SSN:		Title:
Home Address:
City:
State:
Zip:
	Own Rent
Home Phone:
E-mail:
Officer/Owner Information (Owner #2)
Name:		% of Ownership:
SSN:		Title:
Home Address:
City:
State:
Zip:
	Own Rent
Home Phone:
E-mail:
Vendor Information
Name:
Contact:
Address:
City:
State:
Zip:
Phone:
E-mail:
Web Site:
By "submitting" this information you agree to the following:
Everything that I (we) have stated in this application is correct to the best of my knowledge. I am informed that you may request a consumer report (credit report) in connection with this application and that if I ask you, you will inform me if such report was requested and provide me the name and address of the consumer reporting agency that furnished the report. I am also informed that subsequent consumer or business reports may be requested or used in connection with any up-date, renewal or extension of the credit applied for. I authorize you to obtain such report, check my employment and verify any or all information furnished by me on this application.