Printable Equipment Lease Application

Print & Fax Equipment Leasing Application

Please feel free to to print out this application, fill it out and fax it back to us at 1-888-226-0081 If you have any questions you can call us at 1-888-308-7160

Leasefunders.com1350 E. FLAMINGO RD #3329 Las Vegas NV 89119

Phone: 888-308-7160 Fax: (888) 226-0081

EQUIPMENT LEASE APPLICATION

Business Name __________________________________________

Address: ________________________________________

City _______________State _______Zip __________

Contact :_________________________________________

Title __________________Tele# _________________

Fax#________________________

Business Industry:________________________________

Fed ID#__________

Type of Ownership: Proprietorship____ Partnership____ Corporation____ LLC____ Years In Business_______

PRINCIPALS OR OWNERS:

Name______________________________________

Home Address_______________________________

Home City_____________________ST_______Zip_______

Home Phone_________________________________

Social Sercuity # ______________________________

Title__________________Ownership Percent______%

Name______________________________________

Address_______________________________

City_____________________ST_______Zip_______

Home Phone_________________________________

Social Security # ______________________________

Title__________________Ownership Percent______%

BANK REFERENCES:

Bank name ___________________________________;

City ___________________________St___________

Checking Acct#_______________________________

Loan # ______________________________________

Officer Name_________________________________

Phone Number_________________________________

Bank name __________________________________

City __________________________St___________

Checking Acct#_______________________________

Loan # ______________________________________

Officer Name__________________________________

Phone Number_________________________________

TRADE REFERENCES:

Company Name__________________________________________
Telephone#_____________________________

Contact_____________________________ Acct#_____________________
Open Date_______________________

Company Name__________________________________________
Phone #_____________________________

Contact_____________________________ Acct#_____________________Open
Date_______________________

Company Name__________________________________________
Phone #_____________________________

Contact_________________________ Acct#_____________________Open
Date___________________________

VENDOR INFORMATION:

Vendor ______________________________ Contact______________________
ph#________________________

Equipment Description _________________________________________ Equipment
Cost_____________________

Equipment
Location_______________________________________________________

AUTHORIZATION: I hereby authorize the release of all personal or buisness credit or borrowing information requested

by New Horizon Business Services or its assigns for the purpose of this lease application. To the best of my knowledge,

all information contained herein is accurate and true.

Signature _____________________________________________ Date______________________________________