Equiplease Corporation - Lease / Finance Application

APPLICATION
* Legal Company Name:
dba:
Business Address
* Street Address:
* City:
* State:	* Zip
* Phone:	* Fax:
* Type of Business:
* Contact at Firm:
* E-mail Address:
* Date Business Established under current ownership:
BUSINESS OWNERSHIP
* TYPE: Sole Owner Partnership Corporation LLC Other
Owner/President/Partner
* Name: Last	* First * MI
* Title:
* SSN:	- -
* Home Street Address:		* City:
* State:		* Zip:
* Phone:

BANK
* Bank Name/ Branch:
* Business Checking Account Number:
* Officer Name:
* Phone:
* last 3 month average account balance: $1000-$3000 $3000-$6000 $7000-$10000 $10,000-$30,000 $30,000 +
..
TRADES
* 1. Supplier:
* City:		* State:
Zip:
Contact:
* Phone:
* 2. Supplier:
* City:		* State:
Zip:
Contact:
* Phone:

Vendor Name
* Equipment you will lease (briefly describe)

Price of Equipment
$5,000-$15,000 $15,000-$50,000 $50,000-$75,000 $75,000-$100,000
* Initial here to authorized verification of all listed bank and trade references on this electronic application and to release any authorized information requested by EquipLease Corp. By submitting this application the applicant certifies that all information is true and correct.