Loan/Lease Application
Date: Attn:
Dealer: 917 East Beth Drive
Address: Phoenix, AZ 85042
City, State, Zip:
Representative: (800) 444-6424
Phone: (602) 276-5192 (FAX)
Send purchase order via fax regular mail
Authorization to call customer directly Yes No
BORROWER/LESSEE PERSONAL INFORMATION
Trade Name Owner
Legal Name Home Address
Mailing Address City/State/Zip
Street Address Telephone
City State Zip Social Security Number
Telephone Fax Realty Owner: Residential Yes No Business Yes No
FEIN ID# Cell #
Email Address TERMS OF LOAN/LEASE
Contact Officer Title Equipment Description:
Person Signing Lease Title
Proprietorship Nature of Business: Total Cost $ Loan/Lease Term
LLC Comments:
Corporation How many years in Business:
Equipment Location:
Same as Street Address above
STOCKHOLDER/OWNERSHIP
% OF
NAME HOME ADDRESS, CITY, STATE, ZIP SOCIAL SECURITY # OWNERSHIP
1.
2.
3.
4.
Purpose Of Loan/Lease:
FINANCIAL REFERENCES IN BUSINESS NAME ONLY
(Including banks, leasing companies, equipment or other loans)
(Accurate contacts and account numbers will assure a speedy response)
Reference #1 City/State Checking Acct #
Since Phone Contact Lease Loan Acct #
Savings or Money Mkt Acct #
Reference #2 City/State Checking Acct #
Since Phone Contact Lease Loan Acct #
LANDLORD/SUPPLIER REFERENCES
1. Landlord 3. Company Name
Phone Contact/Acct # Phone Contact/Acct #
2. Company Name 4. Company Name
Phone Contact/Acct # Phone Contact/Acct #
THIS IS A COMMERCIAL LOAN/LEASE APPLICATION AND THE EQUIPMENT SHALL BE USED FOR BUSINESS PURPOSES EXCLUSIVELY.
By Signing this Application the individual as principal of and/or guarantor for the applicant, authorizes LeaseCor, Inc., its designee, assigns or potential assigns, to review his/her
personal credit profile provided by national credit bureaus, business and personal bank & financial references, in considering this Application and for the purpose of the update,
renewal, or extension of credit to the Applicant or the collection of any resultant accounts. A fax or photocopy of this authorization shall be valid as the original.
X X
Signature of Person Signing Loan/Lease Signature of Person Signing Loan/Lease