This is an   Equipment Lease Application, if you are looking for a Business Loan Application please click here.
  Referral Partner Password, (if applicable)
If you're not a referral partner and would like to be one please clickhere.
  Referral Partner Name
  Date   
  Firm Name
  Business Address
  City
  State
  Zip
  Business Phone
  Fax
  E-Mail
Tax ID #

How long are you in business (if start up please say so).
Corporation  LLC  Partnership   Individual
Other  Explain

Primary Information
/   1st Principal/Officer  Name
 Title
Home Address / Own Home Y N
  State
  Zip
  SS#
  Home Phone
  Business Phone
  Fax
  E-Mail

/   2nd Principal/Officer  Name
 Title
Home Address / Own Home Y N
  State
  Zip
  SS#
  Home Phone
  Business Phone
  Fax
  E-Mail

  Business Bank Name
  Address
  Account #
  Type of Account
  Bank Representative Name:
  Phone

Where is or will the Equipment be located:
Address
  City
  State
  Zip

Please list 3 trade references.  Include name, address and phone numbers.

Trade reference 1

Trade reference 2

Trade reference 3

Equipment you are leasing:

Equipment 1
  Vendor Name
  Contact Name
  Address
  Phone
  Fax
  Cost
  Tax
  Total
New  Used

Equipment 2
  Vendor Name
  Contact Name
  Address
  Phone
  Fax
  Cost
  Tax
  Total
New  Used

Equipment 3  (if more please submit, then repeat or call us)
  Vendor Name
  Contact Name
  Address
  Phone
  Fax
$  Cost
$  Tax
$  Total
New  Used

How many year lease do you prefer?
Select Here 2years 3years 4years 5years  Other (Maximum, 15yrs on Large Equipment)

Brief Comments

You will be contacted shortly by phone or email with the credit decision or please contact us anytime.

The completion and transmission of the lease application form creates no commitment on the part of the consultant or lender to extend credit, nor does it commit the borrower to accept any credit which might be extended.  Only a written mortgage, loan or leasing commitment fully executed by the lender and borrower is deemed to be binding.

Borrower hereby confirms that the information provided by the borrower and/or principals, submitted with this lease inquiry as well as any subsequent information, is true and correct and may be relied upon by the consultant and the lender in its consideration of a request to extend credit to the borrower.  Borrower here by allows lender to run credit.

I have read the above and agree.

We will be in touch shortly, and thanks for using
eloansource.com