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Financing Agreement

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Financing Agreement Powered By Docstoc
					                                                               Financial Services                                                                                             Randy Freel
LEASE APPLICATION                                                                                                                                                           Fax 404-393-9825
                                                                                      BUSINESS INFORMATION
Business Name                                                                                                          Type of Business


Business Address                                                                                                       City                              State                Zip                  County


Contact                                                                      Title                                     Phone Number                               Fax Number


Business Structure:                   C-Corp.        S-Corp.       Partnership.                                        State of Incorporation                     Date Business Establised/Yrs in Business
                                      Proprietorship        Non-Profit       L.L.C.

Federal Tax I.D. #                                        Corp State ID #                                              Exempt form State Sales/Use Tax?
                                                                                                                       Yes      No       (If yes, include a copy of exemption certificate)

Location of Equipment (if different than business address)


                                                                                        OWNER INFORMATION
  By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to
      Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such
 authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or
additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below,
                                            I/we affirm my/our identity as the respective individual(s) identified in this application.
Owner's Name/Title                                                                               % Ownership           Home Phone Number                          Social Security Number


Home Address, City, State, Zip                                                                   Date of Birth
                                                                                                                                           SIGNATURE_______________________________________________

Owner's Name/Title                                                                               % Ownership           Home Phone Number                          Social Security Number


Home Address, City, State, Zip                                                                   Date of Birth
                                                                                                                                           SIGNATURE_______________________________________________

                                                                                          BANK REFERENCES
Bank Name                                                                    Checking Account Number                   Savings Account Number                     Loan Account Number


Branch/City, State                                                           Contact Officer                           Phone Number                               Fax Number


Bank Name                                                                    Checking Account Number                   Savings Account Number                     Loan Account Number


Branch/City, State                                                           Contact Officer                           Phone Number                               Fax Number


                                                                               TRADE SUPPLIER REFERENCES
Company Name                                                                 Contact                                   Phone Number                               Fax Number


Company Name                                                                 Contact                                   Phone Number                               Fax Number


                                                                      SECURED DEBT (LEASING) REFERENCES
Company Name                                                                 Contact                                   Phone Number                               Fax Number


Company Name                                                                 Contact                                   Phone Number                               Fax Number


                                                                                     TRANSACTION SUMMARY
Equipment Cost (exclusive of sales tax)                                                          Term                                      Payment                                    Purchase Option


Supplier of Equipment                                                        Contact                                   Phone Number                               New                Used
                                                                                                                                                                  If used, yr. of mfgr.

Equipment Description (Mfg., Model Nmbr., S/N, - Attach Sales Order if Available)


                                                                            CREDIT RELEASE AUTHORIZATION
I hereby certify that the information contained in this lease application is true and accurate and I hereby authorize our banks, trade references, and financial institutions the
right to release credit information. By submitting this lease application, Applicant authorizes Tubelite and any assignee of this lease application or any resulting lease or
financing agreement, at any time and from time to time, to discuss and disclose to each other the information obtained on or in connection with this lease application and
any resulting agreement. Applicant represents that this Lease Application is submitted solely for business and commercial purposes, and not for personal, family or
household purposes. A photostat copy of this authorization shall be as valid as the original.
                SIGNATURE__________________________________________________ Title ___________________________________ Date ____________________

EQUAL CREDIT OPPORTUNITY ACT: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact
Financial Services, 329 Jefferson Street, Algonquin, IL 60102, phone: 847-458-0191 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial
within 30 days of receiving your request for the statement. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit 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 applicant's income derives from any public assistance program, or because
the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit
Opportunity, Washington, DC 20580.




                                                   Phone 770-559-3949                        E-Mail: rfreel@financialservicesdept.com

				
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