Leasing Application
Credit Information Release Authorization


To Whom It May Concern:

This document should serve as notice to you that I/we are considering an equipment acquisition. This document will serve as your authorization to release any or all credit information regarding my/our account(s) and any or all corporate financial statements on file to any leasing company, bank or financial institution that may be involved in providing credit accommodations for the acquisition of this equipment.


Your cooperation in promptly responding to any such inquires would be greatly appreciated.

Full Name:
Title:
Legal Company Name:
Address1:
Address2:
City:
State:
Zip:
   Fax:
Phone:
Email:
Credit Application
Company Name:
DBA:
Address:
City:
State:
Zip:
   Fax:
Phone:
Federal Tax ID / SSN # if DBA:
Type of Business:
Number of Employees:
Contact Name:
Title:
Time in Business:
Business Structure
Are You A?:
 Corporation
LLC
Partnership
Sole Proprietorship
Dunn & Bradstreet #:
State of Incorporation:
Personal Information on Principals
REQUIRED ON ALL COMPANIES UNDER 3-YEARS IN BUSINESS and ALL PROPRIETORSHIPS, PARTNERSHIPS, AND LIMITED LIABILITY CORPORATIONS (LLC'S)
 
1
Principle or Officer Name:
Title:
SSN #:
Address:
City:
State:
Zip:
 
2
Principle or Officer Name:
Title:
SSN #:
Address:
City:
State:
Zip:
Trade References
 
Reference #1
Name:
   Fax:
Phone:
Address:
 
Reference #2
Name:
   Fax:
Phone:
Address:
Bank References
 
Bank #1
Name of Bank:
   Fax:
Phone:
Contact:
Account #:
Date Opened:
 
Bank #2
Name of Bank:
   Fax:
Phone:
Contact:
Account #:
Date Opened:
Financed or Leased Equipment (Lender)
Lender:
Account #:
   Fax:
Phone:
Contact Name:
Details
Equipment Costs:
Term Requested:
 		12 month
24 month
36 month
48 month
60 month
Option Requested:
 		FMV (Fair Market Value)
$1.00
10% PUT
 


Disclaimer: By submitting this form you are submitting an electronic signature. This form does not tie you into any agreement of any sort, it only allows us permission to process your information in order to get your exact payment rates.

If you would prefer to fill out this application, print it, sign it, and fax it to us, Please Download Here