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Online Lease Application

General Information

* Indicates required field

Lessee Name *

Address *

Phone *

Email *

Contact Person *

Cell Phone *

Equipment Location *

Type Of Business *

Time In Business *

Business Type *

Dun & Bradstreet Number *

Federal Tax ID *

Banking Information

Bank Name *

Business Checking Account # *

Contact Person *

Bank Phone # *

Personal Information

Name *

Social Security Number *

Home Phone *

Home Address *

If there is more than one owner, please enter their information below.

Name *

Social Security Number *

Home Phone *

Home Address *

Equipment Information

Equipment To Be Leased *

Equipment Cost *

New or Used *

Lease Term *

Vendor Name *

Vendor Address *

Vendor Contact *

Vendor Phone *

PLEASE READ BEFORE CONTINUING

Disclaimer

By submitting an online credit application, you (a) represent that all information provided in the application is true, accurate and complete in all material respects; (b) represent that you are in fact, the individual as to whom such information pertains or an authorized representative of the business entity to which such information pertains; (c) represent that you are 18 years of age or older; (d) represent that you expressly authorized the release of credit information from any source including credit reporting agencies and your bank for the purpose of extending credit and updating your account from time to time; and (e) represent that the proposed transaction is intended solely for business or commercial purposes.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

Confirmation *

By checking this box, you have read and agree to the terms above.

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