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Equipment Leasing Application
COMPANY
INFORMATION (Please list Legal Name. If there is a
d/b/a please indicate)
Legal Name of
Company :
Business Address
:
City/State/Zip :
Billing Address
(if different from above)
Address :
City/State/Zip :
Phone:
Fax :
Cell:
Contact :
Website:
E-Mail Address :
Time in Business
:
Yrs Fed Tax ID #:
# of Employees:
Nature of the
Business :
Type of Business :
OWNER DATA
(Please indicate all owners with
greater than 25% ownership) Attach list if needed
Principal #1
Address :
City/State :
Social Security # :
Principal #2
Address :
City/State :
Social Security # :
REFERENCES
(If you have a Company Reference List,
skip this section and attach)
Business Bank :
Account #
Bank Contact :
Phone:
Fax:
1. Trade Reference :
Phone :
2. Trade Reference :
Phone :
VENDOR'(S) and EQUIPMENT
(If more than one Vendor, attach
List of Vendor's & Proposals)
Vendor Name :
Phone:
Address :
Equipment :
Equipment Cost:
NOTE: Please Enclose a Vendor
Proposal, Invoice or Purchase Order with
full description
LEASE STRUCTURE
(Please enter the lease
structure you are requesting)
Lease term in Months:
End of Lease Option: $1.00
,10%
, fmv
, Other
Applicant certifies that all credit and financial
information submitted is true and correct. Applicant hereby
authorizes First Capital Funding Corporation, its Underwriters
and Assigns to investigate Lessee's credit worthiness, and
disclose their findings to each other. The Undersigned
authorizes all parties contacted to release credit and financial
information as part of said investigation. All duplicates of
this document are to be viewed as an original.
