CUSTOMER SUPPORT
PH
877.455.3273
281.970.7227
FX
877.455.3272
Customer Full Business Name
Name
Address
City
State
Zip
Phone
Fax
Mobile
Contact
Title
Email
Corporation
Proprietorship
Partnership
L.L.C
Years In Business
Date Incorporated
Federal Tax ID
Supplier Name
Name
Phone
Contact
Fax
Mobile
Term
24 Months
48 Months
36 Months
60 Months
Equipment Cost
Equipment Description
New
Used
Personal Information (Officers / Partners)
Percent of Ownership
Name
Phone
Address
City
State
Zip
Social Security #
Percent of Ownership
Name
Phone
Address
City
State
Zip
Social Security #
Business Bank Information
Bank Name
Contact
Phone
Account #
THIS APPLICATION DOES NOT OBLIGATE LESSOR TO ENTER INTO THE LEASE.
The undersigned represents that all information provided with this Application is true and correct and hereby authorizes CreditLease, Inc. (“CreditLease”), or its designee, assigns, or potential assigns to obtain from third parties information it deems necessary to arrive at a decision regarding this Application. By clicking "Agree" below, the undersigned individual(s) as principal of and/or guarantor for the applicant, authorizes CreditLease its designee, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering this Application and for the purpose of update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. I authorize all deposit, borrowing, financial and trade information to be released to CreditLease its designee, assigns or potential assigns by telephone or fax. A photocopy or fax of this authorization shall be valid as the original.
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Creditlease, Inc. Houston, Texas. Copyright © 2007
