EQUIPMENT LEASE APPLICATION

Business Information   * required fields

*Select Appropriate Business Structure: - Choose one - Proprietorship Partnership Corporation(C-Corp) Corporation(S-Corp)

*Business Name/Lessee:

*Contact Name:

*Business Telephone: (XXX-XXX-XXXX)    Business Fax Number:

*Business Address:

*Business City :      *State: - Choose One - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming      *Zip:

*Business County:

Nature of Business(or sic code):

Approx. Annual Revenue:   Age of Business:

Federal Tax Number:

Check if same as above Location of Equipment (Street):

Location of Equipment City :      State : - Choose One - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming      Zip:

Location of Equipment County: