Lessee

 

 

Legal Business Name

 

Address

 

City

  State   Zip 

 

Phone

 

Contact

 

Type Of Business

 

Years in Business

 

Owner Information

 

 

Proprietorship Corporation Partnership

 

Federal Tax ID #

 


 

Officer Name

 

SS#

 

Title

 

Address

 

City

  State   Zip 

 


 

Officer Name

 

SS#

 

Title

 

Address

 

City

  State   Zip 

 

Vendor Information

 

 

Contact

 

Phone

 

Equipment

 

Projected Cost $

 

Term (Months)

36  48  60 

 

Consent

 

  By checking the box, the individual submitting this form, recognizing that his/her individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes the above named business credit provider 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.