Equipment Leasing

Thank you for your interest in equipment leasing

In order to provide you with specific fee and program information we will need the following form completed.

It is not necessary to complete the entire form at this time – providing basic information about your business, trade references and ownership names are sufficient in most cases for us to provide you an initial quote.

Proposals are offered free of charge and at no obligation to you. All inquiries are confidential.



Business Information
Company Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
Years in Business:
Equipment Description:
Please attach an invoice or proposal:

Bank References

Reference #1
Bank Name:
Contact Person:
Phone Number:
Fax Number:

Reference #2
Bank Name:
Contact Person:
Phone Number:
Fax Number:

Reference #3
Bank Name:
Contact Person:
Phone Number:
Fax Number:

Reference #4
Bank Name:
Contact Person:
Phone Number:
Fax Number:

Trade References

Reference #1
Trade Name:
Contact Person:
Phone Number:
Fax Number:

Reference #2
Trade Name:
Contact Person:
Phone Number:
Fax Number:

Reference #3
Trade Name:
Contact Person:
Phone Number:
Fax Number:

Reference #4
Trade Name:
Contact Person:
Phone Number:
Fax Number:

Ownership Information

 Please list all owners having a 20% or greater ownership interest

Owner #1
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
SSN:
Ownership %:

Owner #2
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
SSN:
Ownership %:

Owner #3
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
SSN:
Ownership %:

Owner #4
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
SSN:
Ownership %:

Owner #5
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone Number:
SSN:
Ownership %: