Leasing Application E-Mail Form

LESSEE COMPANY INFORMATION Full legal name of company
Contact Email
Company Name
Trade Name or DBA *
Tax I.D. Number
Billing Address
City
State
Zip
Nature of Business
Telephone
No. of Years in Business
Type of Business	LLC Non-profit Prorietorship Partnership Corporation
No. of Employees
PERSONAL INFORMATION Officers, Partners, and Guarantors
Name
Title
Social Security Number
% Ownership
Home Adress
City
State
Zip
Name
Title
Social Security Number
% Ownership
Home Adress
City
State
Zip
COMPANY BANK REFERENCE Two year history
Name of Bank / Branch
How long (Years)
Telephone
Checking Account #
Contact Officer
Need on projects OVER $25,000 TRADE REFERENCES Two year history
Name of Supplier / Acct.#
City/State
Telephone
Contact
Name of Supplier / Acct.#
City/State
Telephone
Contact
EQUIPMENT DESCRIPTION
New Location (if Applicable)
City
State
Furniture Cost:
Term (Months)	24 36 48 60
Description of Furniture to be Financed