2309 N. Hullen St. Metairie, Louisiana 70002
Phone:  504-835-5151    Fax:  504-454-2025     800-xxx-xxxx

EQUIPMENT LEASE APPLICATION

All Information is Kept Strictly Confidential!

Company Information
Company Name
Phone
Corporate Name
Billing Address
City/State/Zip
Equipment Location
if other than billing addaxes
Years in Business
Nature of Business
Federal Tax ID
Type of Business Sole Proprietorship Partnership
Corporation             Other
 

Bank Preferences

Bank Name
Bank Phone
Acct. No.
Bank Officer Name
Type of Acct. Business Personal
   
Bank Name
Bank Phone
Acct. No.
Bank Officer Name
Type of Acct. Business Personal

Trade Preferences

1) Trade Reference
Phone
Acct. No.
2) Trade Reference
Phone
Acct. No.
3) Trade Reference
Phone
Acct. No.

Equipment Vendor Information

Vendor Name
Vendor Contact
Phone
Equipment Cost (w/o tax)
Term of Lease 13 Months 24 Months 36 Months
48 Months 60 Months
Purchase Option $1.00 Buyout Fair Market Value

List Equipment

Item # Quantity  
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Fax separate list if more equipment is needed

For Ownership, Partnerships, or Close Corporations

Principal's Name
Principal's SSN
Principal's Title
Principal's Home Address