Lessee
Please be sure to list exact legal name of entity
Company
DBA
Address
City
County
State
Zip
Country
Phone
Fax
Contact Person
Email Address
Title
Year Business was Established
Nature of Business
Type of Business
Corporation
Partnership
Proprietorship
Non-Profit
Federal Tax ID Number
Equipment Location
(If different from above address)
Lease Amount
Factor
Months
Payments
Number of Advance Payments Collected
Comments
Purchase Options
FMV
10%
$1.00
Equipment To Be Leased
Attach separate list if necessary
Manufacturer
Description (model number)
Total Cost
Vendor Name
Vendor Address
Contact
Phone
Fax
Computer Equipment
% Hardware
% Software
Personal Information On Officers, Partners, or Guarantors
Name
Percent Ownership
Title
Phone
Social Security Number
Date of Birth
Home Address
City
State
Zip
Name
Percent Ownership
Title
Phone
Social Security Number
Date of Birth
Home Address
City
State
Zip
Company Bank References
Minimum two year history.
Important to Establish Any Loan History
Name of Bank/Branch
Years
Checking Account No.
Phone
Fax
Name of Bank/Branch
Years
Checking Account No.
Phone
Fax
Trade References
Minimum two year history.
Important to Establish High Credit and Payment History
Name of Supplier
City
State
Account No.
Phone
Fax
Name of Supplier
City
State
Account No.
Phone
Fax
* Financial statements and/or tax returns may be required.
The undersigned certifies that the information given for credit purposes is true and correct; authorizes
ABCO LEASING
its assigns, and any credit bureau or other investigative agency to investigate the references, statements, and other information accompanying this application; and, expressly authorizes that bank and trade references listed above to release credit and information requested as part of said investigation. A copy is valid as an original signature.
