Lease Application (Business)  
COMPANY INFORMATION
LEGAL COMPANY NAME
ADDRESS
CITY
STATE
ZIP
PHONE
(format: xxx-xxx-xxxx)
FED. TAX I.D. #
(format: xx-xxxxxxx)
CONTACT PERSON
E-MAIL ADDRESS
TYPE OF BUSINESS
Corporation   Proprietorship   Partnership
STATE OF INCORPORATION
TIME IN BUSINESS (Under Current Ownership)
# OF EMPLOYEES
DESCRIPTION OF BUSINESS
BILLING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP
OWNERS - PARTNERS - OFFICERS
NAME
HOME ADDRESS
HOME PHONE
(format: xxx-xxx-xxxx)
CITY
STATE
ZIP
SOCIAL SECURITY #
(format: xxx-xx-xxxx)
TITLE
EVER BANKRUPT?
Yes
No
% OWNERSHIP
NAME
HOME ADDRESS
HOME PHONE
(format: xxx-xxx-xxxx)
CITY
STATE
ZIP
SOCIAL SECURITY #
(format: xxx-xx-xxxx)
TITLE
EVER BANKRUPT?
Yes
No
% OWNERSHIP
REFERENCE DATA
LIST PRESENT BANK(S) - PREVIOUS BANK IS REQUIRED IF APPLICANT HAS BEEN AT PRESENT BANK LESS THAN TWO YEARS
PRESENT BANK OF APPLICANT
BRANCH
PHONE
(format: xxx-xxx-xxxx)
NAME OF BANK OFFICER
ACCT. #
PREVIOUS OR SECOND BANK OF APPLICANT
BRANCH
PHONE
(format: xxx-xxx-xxxx)
NAME OF BANK OFFICER
ACCT. #
TRADE REFERENCE 1 NAME AND ADDRESS
PHONE
(format: xxx-xxx-xxxx)
HIGH CREDIT
ACCT# or CONTACT
TRADE REFERENCE 2 NAME AND ADDRESS
PHONE
(format: xxx-xxx-xxxx)
HIGH CREDIT
ACCT# or CONTACT
TRADE REFERENCE 3 NAME AND ADDRESS
PHONE
(format: xxx-xxx-xxxx)
HIGH CREDIT
ACCT# or CONTACT
SUPPLIER INFORMATION
EQUIPMENT SUPPLIER
VENDOR CONTACT
PHONE
(format: xxx-xxx-xxxx)
EQUIPMENT SUPPLIER ADDRESS
INSURANCE AGENT
PHONE
(format: xxx-xxx-xxxx)
LEASE INFORMATION
DESCRIPTION OF PRODUCT
PAYMENT AMOUNT
PRODUCT COST
LEASE TERM
EQUIPMENT
NEW USED RECONDITIONED DEMO

By signature below, the undersigned individual, acting with due and proper authority from Applicant, authorizes and grants express permission
to 1st Independent Leasing Inc. to communicate with Applicant pertaining to marketing, promotions, specials, advertisements and all other business-related
matters and more particularly to send to Applicant unsolicited communications pertaining to the above purposes. The Undersigned acknowledges that the
form of communication may be through fascimile by faxing to the following dedicated facsimile number:

to the attention of the undersigned Applicant or by electronic mail to the email address of:

Please note that you may "opt out" of receiving either or both (at your choice) of faxes or emails by either (a) informing us in writing or (b) replying to an
email. Applicant further agrees that this authorization shall remain in full force and effect until revoked by Applicant in the manner aforesaid.

USA Patriot Customer Indentification Notice
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an accountt.

What this means for you: When you open an account, we will ask you for your name, address, date of birth, and other information that will allow
us to identify you. We may also ask to see your driver's license or other identifying documents. By signing below, the undersigned individual, who is either a
principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to 1st Independent Leasing or its designee (and any
assignee or potential assignee therof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to
obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit
and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we
affirm my/our identity as the respective individual/s identified in the above application.

By entering my first & last below, I stipulate that I agree to all of the terms and conditions stipulated on this application.
*Signature:        Enter first & last name