Customer Application

Please complete the form below to submit your application online, checking the information below you will be uploading online along with your application.

Please note that other information may be requested at any time. Your application is secure and we do not share any of your information.

Business Information

Business Legal Name*

D / B / A Name (if any)

Entity Type*

Sole Proprietorship
Partnership
C Corporation
S Corporation
Limited Liability Company
Other

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name*

First Last

Title

Phone*

Email*

Equipment & Vendor Information

Equipment Description*

Equipment Type*

New
Used

Equipment Cost*

exclude tax

Desired Term*

End of Term Options*

FMV
$1 Buyout

Vendor Name*

Contact Person*

First Last

Phone Number*

Business Consent & Authorization

I authorize all deposit, borrower and trade account information to be released to the Lessor. I hereby represent all information is true, correct and complete. A photostat, electronic or facsimilie copy of this authorization shall be valid as the original.

Officer or Principal Digital Signature*

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against 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 applicants income is derived from a government assistance program or because the applicant in good faith has exercised any right under the Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, DC 20580.

If you application for credit is denied, you have the right to a written statement as to the specific reasons of the denial. To obtain this statement, please contact the lessor set forth above within 60 days from the date you are notified of the decision. We will send you a written statement of reasons within 30 days of receiving your request for the statement.

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Name

This field is for validation purposes and should be left unchanged.

Please complete the form below to submit your application online, checking the information below you will be uploading online along with your application.

Business Information

Equipment & Vendor Information

Business Consent & Authorization

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