LESSEE'S INFORMATION:
The complete & correct business name
Company Name:___________________________________________________________
Address:___________________________________________Phone:_________________
City:_________________________County:______________State:_____Zip:___________
Include state/county sales tax % if known
BUSINESS INFORMATION:
Years in Business____________________ TYPE OF BUSINESS:____________________
Total Years Under Same Ownership:_________
Please Check One
__ Proprietorship __ Partnership __ Corporation
Principals: (Owner) (Partner) (President)
Name & Title
Home Address with Zip
Social Security #
______________________ __________________________________
_______________
______________________ __________________________________
_______________
______________________ __________________________________
_______________
EQUIPMENT and DEALER INFORMATION:
Equipment Description __________________________________________ __ New __ Used
Vendor Name/Contact ________________________________Total Lease Amount $______
Address/Telephone:__________________________________________________________
BANK INFORMATION:
2 year history needed - provide former bank information
if necessary
Bank Name \ Branch_________________________________________________________
Location: ______________________________________________ ___________________
CITY
STATE
Contact Person:______________________________Telephone: (
)__________________
Account Number: _______________________________________________
BUSINESS BANK ACCOUNT
LOAN OR LEASE REFERENCES: If no loans or leases, please list 3 trade references.
Name
Address (City & State)
Phone #
Contact
1_________________________________________________________________________
2_________________________________________________________________________
3_________________________________________________________________________
The undersigned applicant(s) for credit understand that information supplied, and their personal credit history, may influence
the final decision to approve this
transaction. Credit Inquiry Authorization: I/We hereby consent to, and authorize Leasing Solutions, Inc., and any assignee, lender, or funding service that may be
utilized, to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process, and
waive any right or claim I/We would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent.
Signature________________ Signature_________________ Signature_____________________
Date___________________ Date____________________ Date_________________________