EQUIPMENT LEASE / FINANCE APPLICATION COMPANY INFORMATION
Company Name
Federal Tax ID
Company Address
Telephone No.
Fax
Nature of Business
No. of Years in Business
Type of Business Proprietorship
Partnership
LLC
Corporation
Non-Profit
PERSONAL INFORMATION Officers / Partners /
1) Name
Title
% Owned
Monthly Household Income
Home Address
Own
Rent
Social Security No.
Date of Birth
Personal Phone
2) Name
Title
% Owned
Monthly Household Income
Home Address
Own
Rent
Social Security No.
Date of Birth
Personal Phone
COMPANY BANK REFERENCE - Five-Year History
1) Name of Bank / Branch
How Long
Telephone No.
Checking Acct. No.
Contact Officer
2) Name of Bank / Branch
How Long
Telephone No.
Checking Acct. No.
Contact Officer
LEASE / LOAN REFERENCES
1) Lender
Acct. No.
Loan Amount
Telephone No.
Contact
Amount Paid
2)
Acct. No.
Loan Amount
Telephone No.
Contact
Amount Paid
TRADE REFERENCES
1) Supplier
Telephone No.
Contact / Acct #
2) Supplier
Telephone No.
Contact / Acct #
3) Supplier
Telephone No.
Contact / Acct #
EQUIPMENT / VENDOR INFORMATION
Equipment Description
Vendor Name
Vendor Address
Telephone No.
Equipment Cost $
New
Used
Term
Vendor Contact
DECLARATION The undersigned individual, on behalf of themselves and all others listed on this application recognizing that their individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes Quail Equipment Leasing and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent.
Applicant Name *
Consent and Authorize
Title *
Primary email *
Date *
Image Verification
