Jim Stanislowski (720) 352-6120
jims@leaseprocess.com
Company Information
Legal Company Name
*
DBA Name
Street Address
City
State
Zip Code
Contact Name
*
Phone
*
Email
*
Nature of Business
Corp / Other
Please choose an option
Corp
LLC
Partnership
Sole-Prop
Years in Business
Location of Equipment
If different from Business Address
Years at Location
Estimated Equipment Delivery Date
MM slash DD slash YYYY
Equipment Quote
Amount
*
Term (months)
-
24
36
48
60
Payment
Adv. Pmts
-
0
1
2
Buy Out
-
$1.00
10%
FMV
New/Used
-
New
Used
Equipment Description
Personal Information for all Owners, Officers and Guarantors
Name
Title
SSN
% of Ownership
Home Phone
Street Address
City
State
Zip Code
Name
Title
SSN
% of Ownership
Home Phone
Street Address
City
State
Zip Code
Add another co-owner
Name
Title
SSN
% of Ownership
Home Phone
Street Address
City
State
Zip Code
I/We hereby authorize LeaseProcess, its designee, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of updating, renewing, extending additional credit or the collection of any late account. I/We hereby authorize our references to release all credit information and I/We represent and warrant that the information submitted herein is true, complete and accurate. A facsimile, electronic or other copy of this authorization shall be as valid as the original.
*
I/We agree to the LeaseProcess Credit Authorization Terms
