Business Leasing Company

Credit Application
THE MINIMUM AMOUNT FOR AN EQUIPMENT TRANSACTION IS $2,500.

Thank you for choosing Business Leasing Company for your business solutions. Please fill out the information requested below. You will be contacted as soon as a credit decision has been made.

All fields marked with an * are required within a required section. If you type anything in a non-required section, then all fields with an * are required. If a section is not required, then you may skip that section.

E-Mail Notification
Enter your e-mail address to receive a confirmation letter.

E-Mail Address*

Business Information
Please enter the correct legal name of your company.
Example: If you are a Sole Propreitor it should read, "John Doe dba XYZ Company".

Company Name *
Doing Business As (DBA)
Address Line 1 *
City *
State/Province *
Zip/Postal Code *
County
Company Phone *	###-###-####
Company Phone Ext
Contact Name *
Contact Cell Phone	###-###-####
Fax	###-###-####
Business Structure *
Date Company Formed (mm/yyyy) *
Federal Tax ID *

Lease Detail
Please enter approximate amount of your request and the term you want. Once the application has been approved we can change the amount or term to suit your needs.

Amount *	###.## (dollar range of $2,500 to $75,000)
End Of Lease Buyot
Lease Term
Monthly Payment	###.##

Guarantors
LIST ALL OWNERS HAVING MORE THAN 25% AND THEIR PERCENTAGE OF OWNERSHIP

Guarantor 1 - required
Title *
First Name *
Middle
Last Name *
Ownership % *	### (Do not use a percent sign or decimal.)
SSN *	###-##-####
Street Number (home) *
Street Direction (home)
Street Name (home) *
Street Type (home)
Apartment Number
City *
State/Province *
Zip/Postal Code *
Phone *	###-###-####

Bank References

Bank Reference 1 - required
Bank Name *
Contact
Phone *	###-###-####
Fax	###-###-####
Account Type *
Account Number *

Bank Reference 2
Bank Name *
Contact
Phone *	###-###-####
Fax	###-###-####
Account Type *
Account Number *

Trade References

Trade Reference 1 - required
Business Name *
Contact
Phone *	###-###-####
Fax	###-###-####
Account Number

Trade Reference 2 - required
Business Name *
Contact
Phone *	###-###-####
Fax	###-###-####
Account Number

Equipment

Equipment Description
Vendor Name
Contact Name
Contact E-Mail	name@company.com
Contact Cell	###-###-####

Authorization

By checking this box, Applicant represents and warrants that all credit and financial information submitted to Business Leasing Company is true and correct. You also agree that Business Leasing Company or their assigns may obtain any information necessary pertaining to this application including, but not limited to owners, officers or guarantors. Applicant agrees to furnish financial statements upon request. Applicant authorizes Business Leasing Company or any credit bureau or other investigative agency employed by Business Leasing Company to investigate the references, statements or other data herein listed.

By checking this box, Applicant gives and acknowledges a digital signature that replaces the need for a physical signature for authorization to release credit information.