Leasing Innovations

Vendors

-Brokers

-Investors

Credit Application

Please fill out the form completely

COMPANY INFORMATION(Please state EXACT legal name of entity registered with the state)

BUSINESS NAME:

D/B/A:

ADDRESS:

CITY:

ST:

ZIP:

CONTACT NAME:

TITLE:

PHONE:

FAX:

EMAIL:

YRS IN BUSINESS:
(IE: 25)

BUSINESS STRUCTURE: CORP S’CORP PARTNERSHIP PROPRIETORSHIP LLC

DESCRIPTION OF BUSINESS:

PROPOSED LEASE TERMS (Please provide as much detailed information as possible)

AMOUNT REQUESTED:
$

DOWNPAYMENT AVAILABLE:
Yes No

DOWNPAYMENT:
$

LEASE TERM (Yrs):
1 3 5

PAYMENTS:
Monthly Quarterly Semi-Annual Annual

EQUIPMENT DESCRIPTION:

EQUIPMENT PURPOSE / USE:

PERSONAL INFORMATION (Needed for all applications)

GUARANTEE AVAILABLE:
Yes No

NAME:

SSN:

% Owner:

ADDRESS:

CITY:

ST:

ZIP:

NAME:

SSN:

% Owner:

ADDRESS:

CITY:

ST:

ZIP:

BUSINESS REFERENCES (1) Bank & (3) Trades REQUIRED if not supplied application will be rejected)

1 :: BANK NAME:

ACCOUNT #:

PHONE:

FAX:

1:: TRADE NAME:

CITY:

ST:

ZIP:

CONTACT:

PHONE:

FAX:

2:: TRADE NAME:

CITY:

ST:

ZIP:

CONTACT:

PHONE:

FAX:

3:: TRADE NAME:

CITY:

ST:

ZIP:

CONTACT:

PHONE:

FAX:

VENDOR INFORMATION (Email quote or equipment description if available)

VENDOR NAME:

CONTACT:

ADDRESS:

CITY:

ST:

ZIP:

E-MAIL ADDRESS:

PHONE:

FAX:

Dear Credit Grantor: Please consider this application or a fax thereof my binding agreement and acceptance of the proposed lease terms, subject to your credit approval. I/We understand and agree that if I/We am credit approved for the proposed lease terms, and I/We for any reason do not complete the lease transaction and formal lease documents, then I/We will be charged a one time seventy five dollars ($75.00) credit investigation fee and I/We agree to remit upon receipt of invoice. Please consider this application or fax thereof my authorization to furnish a complete history of all accounts, loans, transactions, trade information, balances or other financial information relative to any account we may have with you. I/We grant Leasing Innovations, Incorporated permission to investigate any credit sources necessary to underwrite this credit request. I/we release Leasing Innovations, Incorporated from any liability arising from its credit investigations.

SIGNED:

TITLE:

DATE:
(mm/dd/yy)

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