Lease Application

Years In Business:

Lessee Company Name:

Lessee Address:

Telephone:

Fax:

City:

State/Province:

Zip Code:

DBA:

Type Of Business:

Equipment Location:

Contact:

Bank

City/State

Contact:

Account No.:

Telephone:

1.

2.

3.

LandLord:

Telephone:

Principal Name:

1.

2.

3.

Home Address:

City, State, Zip:

Home Telephone No:

Social Security:

% of Ownership:

Dealer Name:

City, State, Zip:

Address:

Fed. Tax I.D.

Contact:

Telephone:

Equipment Description:

Equipment Costs:

Lease Payment:

Term:

Estimated Delivery Date:

FOR THE PURPOSE OF SECURING LEASE FUNDING, I AUTHORIZE ALL BANK DEPOSIT, CREDIT, TRADE AND BORROWING INFORMATION TO BE RELEASED BY TELEPHONE OR FACSIMILE TRANSMISSION.