Financial References Lease by smh16695

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									                                                                                                                               AmeriTel Financial Services, Inc.
                  Lease Application
                                                                                                                               6755 Jimmy Carter Blvd., Norcross, GA 30071
                        www.ameritelfinancial.com
                                                                                                                               Fax (800) 780-7368    Phone (800) 788-7368

LESSEE (Complete legal name of entity. If a corporation, use EXACT registered corporate name.)
Legal Business Name                                                                                  DBA



Billing Address                                                                               City                               State                                                Zip



Telephone Number                            Fax Number                           Email Address to Lease Documents                                                 Contact Name



Location of Equipment (if different from address above)                                       City                               State                                                Zip



Description                         Federal ID or D&B Number           Type of Business                                                                                                       No. of YRS in Business
                                                                                           Proprietorship                     Corp. (Registered in the state of         )

                                                                                Partnership                           Non-profit Corp. (Registered in the state of                )


PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS
Name                                                           Title with % Ownership                                  Date of Birth                                    Social Security No.


Home Address                                                   City                                      State                                    Zip Home                            Phone No.



Name                                                           Title with % Ownership                                  Date of Birth                                    Social Security No.


Home Address                                                   City                                      State                                    Zip Home                            Phone No.



TRADE REFERENCES - TWO YEAR HISTORY
(1)                                                                              Contact                                                                                Phone No.

(2)                                                                              Contact                                                                                Phone No.

LEASE OR LOAN REFERENCES - TWO YEAR HISTORY
(1)                                                                    Lease or Loan No.                               Phone No.                                        Contact



BUSINESS BANK REFERENCES - TWO YEAR HISTORY
Present                                                        Account #                                          Phone No.                                             Bank Officer


Present                                                        Account #                                          Phone No.                                             Bank Officer



PAYMENT PLAN
              Term                                Factor                      Lease Payment                         FMV                          New Business           Security Deposit               0 Down

                                                                                                                 $1.00 Buyout                   Tax Exempt                                             1 Down

                                                                                                                 10% Purchase                     Other                                                2 Down

EQUIPMENT TO BE LEASED (Attach separate list if necessary.)
Description                                                                                                                                                                                 Equipment Cost without tax


                                                                                                                                                                                       $
Dealer's Name and Contact:
The undersigned has contracted to lease equipment from AmeriTel Financial Services, Inc. and as a routine part of their business procedures, a bank and trade reference are requested. This is my authorization to
release any information they requested by telephone or fax as part of their normal credit approval procedures.


Authorized this                                            day of                                    ,

Company name                                                                                                      Signature                                                       Title

								
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