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"Service" is still part of OUR Service!

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Leasing Form
Leasing and Rentals

Application Data
Legal Company Name
Address
City
State
Zip
Phone
Person to Contact
Title
Brief History of Company
Federal Tax I.D.#
Tax Exempt
1. Principal Owner
% of Ownership
Title
Address
City/State/Zip
2. Principal Owner
% of Ownership
Title
Address
City/State/Zip
Entity Type Corporation
Partnership
Proprietorship
Affiliated Companies or Subsidiaries

Insurance Information
Insurance Company Name (Liability & Physical Damage)
Agent

Credit References
Bank Name
Contact
Finance Company
Contact
Finance Company
Contact

Trade Information
Company Name
Products/Supplies
Contact
Company Name
Products/Supplies
Contact

Proposed Equipment Description
Year
Make
Model
Specification
Delivery Date
Cost
Year
Make
Model
Specification
Delivery Date
Cost
Year
Make
Model
Specification
Delivery Date
Cost

Existing Equipment
Please explain specific use and life cycle of equipment
In completing this form, you certify that the above information given for credit purposes is true and correct and authorizes the firm or person to whom this application is made and any credit bureau investigation agency to investigate the references, statements or other data listed or accompanying this application. In completing this form, you authorize all parties contacted to release credit and financing information requested as a part of said investigation.
 
 




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