| How did you hear about Real Lease? |
Radio
Yellow Pages
Referred by:
Other:
Term Requested:
Date:
Lease Rep.:
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| APPLICANT INFORMATION |
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VENDOR INFORMATION |
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Name:
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Name:
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Address:
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Address:
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City, State, Zip:
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City, State, Zip:
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County:
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County:
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Contact Person:
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Contact Person:
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Title:
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Title:
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Phone:
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Phone:
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Fax:
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Fax:
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E-mail:
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E-mail:
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| PRINCIPAL(S)/GUARANTOR(S) INFORMATION |
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Person (1) :
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Person (2) :
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Home Address:
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Home Address:
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City, State, Zip:
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City, State, Zip:
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Phone:
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Phone:
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Title:
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Title:
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% Ownership of Co. :
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% Ownership :
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Social Sec# (required):
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Social Sec# (required):
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Own or Rent Home :
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Own or Rent Home :
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How Long? :
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How Long? :
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Monthly Payment :
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Monthly Payment :
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Net Worth :
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Net Worth :
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Annual Income :
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Annual Income :
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| EQUIPMENT AND BUSINESS DESCRIPTION |
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Equipment Description :
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Cost :
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Is the equipment location the same as the applicant’s address?
Yes
No |
Business Description :
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Corp
S Corp
Proprietorship
General Partnership
Limited Partnership
Other:
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Business Start Date :
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Annual Sales :
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SIC Code (if known) :
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# Employed :
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Years operated under current management :
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Fed. Tax ID # :
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| BANK REFERENCES |
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1. Bank Reference :
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Account Type :
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Address:
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Account # :
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City, State, Zip:
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Phone :
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Contact Name :
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2. Bank Reference :
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Account Type :
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Address:
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Account # :
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City, State, Zip:
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Phone :
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Contact Name :
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| TRADE REFERENCES |
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1. Trade Reference :
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Account # :
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Address:
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Phone :
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Contact Name :
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2. Trade Reference :
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Account # :
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Address:
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Phone :
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Contact Name :
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3. Trade Reference :
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Account # :
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Address:
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Phone :
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Contact Name :
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| MISCELLANEOUS |
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Is the Applicant and/or Guarantor an endorser, guarantor, or co-maker for obligations (including any lease obligations,
e.g.,vehicle, equipment lease of business location) not listed on its financial statements?
If yes, please explain:
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Yes
No |
Is the Company and/or any Guarantor a party to any lawsuit or subject to any outstanding judgments?
If yes, please explain:
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Yes
No |
Company and/or Guarantor ever declared bankruptcy?
If yes, please explain:
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Yes
No |
Are any of the Company’s or any proposal Guarantor’s taxes past due?
If yes, Owed to:
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Yes
No |
Are there any assets pledged or mortgaged other than as stated on the business financial statements submitted? Details :
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Yes
No |
Are any payments late? If yes, please explain:
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Yes
No |
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Notice to all applicants with annual gross revenues of $1,000,000 or less: If your application for business credit is denied,
you have the right to a written statement of the specific reason(s) for the denial. To obtain the statement, please write to Real Lease, Inc.
within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of
our receiving your request.
Applicant’s Statement: I authorize Real Lease, Inc., its agents, assigns and or its nominees, to request, verify and review all data you
require about the Company and the principals and guarantors, including credit reports from agencies, now and for any future review of this
application or for collection of payments. I authorize you to give credit information about me and the Company to others. I agree that your
application and documentation fees are non-refundable. All the information I have delivered is correct and complete, except that alimony, child
support and separate information on the applicant and/or proposed guarantors as may be required.
Yes
No
Bank Statement: I hereby authorize you to release any pertinent or request information pertaining to my (our) bank accounts to Real Lease,
Inc. and/or its agent(s) or assigns.
Yes
No
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