Application for Leasing

SUPPLIER

LESSEE

No. of Years in Business

Type of Business:      Non Profit      Proprietorship      Partnership      Corporation

May we call Lessee?      Yes      No

EQUIPMENT TERM RENT

ADVANCE RENTAL PAYMENT

Check ONE only:

REFERENCES (Important to establish any loan history and highest trade references)

Bank Reference - Two Year History

Bank Name:    Officer to Contact:

Address:

City: State: Zip:

Telephone:

Checking Acct. No.:    Loan Acct. No.:

Bank Name:    Officer to Contact:

Address:

City: State: Zip:

Telephone:

Checking Acct. No.:    Loan Acct. No.:

Trade Reference and Previous Leases – D&B Rating

Name:     Contact:

Address:

City: State: Zip:

Telephone:

Name:     Contact:

Address:

City: State: Zip:

Telephone:

PERSONAL DATA

Name:     Title:

Address:

City: State: Zip:

Telephone:         SSN:

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