EQUIPMENT LEASE CREDIT APPLICATON

 
 
 

 

 

 


The business equipment you are acquiring can be leased under the following terms:

TOTAL EQUIPMENT COST: $_______________       Term:_____mos.         Rate Factor Used:___________

Monthly Payment (plus applicable taxes): $__________   Purchase Option: ____________________________

Advance Rentals: $______________   Security Deposit $________________    Other:____________________

LESSEE INFORMATION
 
__________________________________________________________________________________________

 

 

Full legal Business Name: _____________________________________________________________________

                                                                                                                                                Contact Person

Address: ___________________________________________________________________________________

                  Street                                                                       City                                       County                   State                    Zip

 

E-Mail: ___________________________________    Internet Address: _________________________________

 

Phone: ________________ Fax: ______________    Federal Tax ID #: _____________   Years in Business: ___

 

Nature of Business: _____________________________________________________   Years of Ownership: ___

 

State of Incorporation/Organization:_________Business Type: oCorp.oLimited Liability Corp.oPartnership oPropietorship

OWNERS, PARTNERS OR GUARANTORS
 
 

 

 


1)    Name: _______________________________________  Title: ____________________________  SS#: __________

 

Home Address: ___________________________________________________   Home Phone: ____________________

 

2)       Name: _______________________________________  Title: ____________________________  SS#: _________

 

        Home Address: ___________________________________________________  Home Phone: ____________________

BANK INFORMATION
 
 

 

 


Name of Bank: ______________________________________   Bank Officer: ____________________________________

 

Phone #: ____________________  Deposit/Check Acct. #: ________________________    Loan #: ___________________

 

Name of Bank: ______________________________________   Bank Officer: ____________________________________

 

Phone #: ____________________   Deposit/Check Acct. #: ________________________     Loan #: __________________

TRADE REFERENCE
 
 

 

 


Name of Supplier: ____________________________________________   Contact: _________________________________

 

Address: _______________________________________________________  Phone: ________________________________

VENDOR INFORMATION
 
 

 

 


Name:  Empire Equipment Company                                                           Contact:  Gary Emigh

Street Address: 4607 N. 4th Avenue,                 City       Sioux Falls            County    Minneahaha                 State  SD                   Zip      57104

Phone: (800) 366-3023                           Fax: (605) 731-0059                                          E-Mail: gary@empireequipmentco.com

The person(s) supplying the above information certifies to the leasing company that it is true and correct.  The Owners/Partners/Guarantors

recognize that their individual credit histories may be a factor in the evaluation of the lease applicant and, thus, authorize the leasing company or

 its designee to investigate their personal credit status,  This includes obtaining and using their consumer credit reports from time to time in the

credit evaluation and collection processes.