Please complete the following lease application.  A sales associate will be contacting you shortly after, to confirm credit approval.

Applicant's Credit Information

Please provide the applicant's contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

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What is the applicant's type of business?

Proprietorship Partnership Corporation

How long has your company been in business?

0-2 years 2-5 years 5-10 years 10+ years

What is your company's tangible net worth?

<$500k $500k to $1M $1M to $5M >$5M

Please provide a trade, bank or finance reference:

Contact Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Account #
E-mail

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Please provide a second trade or finance reference:

Contact Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Account #
E-mail

Equipment Information and Description

Please provide the equipment vendor information:

Sales Person
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

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Is the equipment new or used?

New Used

How long would you like to lease this equipment?

24 months 36 months 48 months 60 months

What is the cost of equipment before taxes?

$

Would you like to take advantage of our Easy Start Program with deferred payments?

Yes
No

Please provide any specific equipment information:

Product Name
Model
Serial Number

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Principles or Guarantor Information

Please provide the first principle or guarantor information:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Social Security #
% of Ownership
E-mail

Please provide the second principle or guarantor information:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Social Security #:
% of Ownership
E-mail

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