Leasing App - Alliance Financing Group

BUSINESS LEASE CREDIT APPLICATION

Equipment Supplier:*

Term Requested:*

Amount $*

Equipment Supplier Contact:*

Equipment Supplier Phone:*

Equipment Supplier Email:*

Equipment:*

Equipment Status:*

NEW USED

If used, what year is the equipment?

PRINCIPALS OF THE COMPANY

Legal Name:*

First Name

Last Name

Title:*

% Ownership:*

SIN/SSN:*

Date of Birth:*

Phone:*

Address:*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Legal Name:

First Name

Last Name

Title:

% Ownership:

SIN/SSN:

Date of Birth:

Phone:

Address:

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Canadian Applicants:*

You confirm that the information you have given us in respect of this application is true and complete, and you authorize us to rely on and use this information in order to confirm your identity and evaluate your credit worthiness, in relation to the financing contract being entered into.  In particular, you agree that we, our affiliates and any third parties acting for us or on our behalf (hereinafter collectively “us”, “we” or “our”), may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor, and may hold, use, exchange and disclose such information for the purposes identified above.  If your application is approved, you authorize us to collect, hold, use, exchange and disclose your personal information, as required, in order to administer your contract, determine your insurance eligibility, and secure the assets being financed, or as required or permitted by law.  You also authorize us to use your personal information for internal statistical analysis purposes.  We will keep a file containing some or all of your personal information at 95 Royal Crest Court, Suite 3, Markham, Ontario, L3R 9X5 from time to time.  You have a general right to access and rectify the personal information in this file by making a written request to the above address, attention: privacy office.

US Applicants:*

I hereby certify: (i) the information provided above is true and correct, (ii) you, your affiliates and any third parties acting for you or on your behalf (hereinafter collectively “you” or “your”) are hereby authorized to investigate all bank, credit, and trade references, and said references are hereby authorized to release any requested information to you or your nominee, (iii) 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, (iv) this information may be transmitted by us to you and by you to underwriter/s for the purpose of granting to me credit, either electronically or manually, and that by submitting this application, I take full responsibility for transmission thereof, (v) I am over 18 years of age, (vi) I acknowledge my rights under the Fair Credit Opportunity Act, and (vii) this request is for business and not consumer purposes.

Name:*

First Name

Last Name

Title:*

Date:*

Authorized Signature:*

[clear]

Use your mouse or finger to draw your signature above

Name:

First Name

Last Name

Title:

Date:

Authorized Signature:

[clear]

Use your mouse or finger to draw your signature above

BUSINESS LEASE CREDIT APPLICATION

COMPANY INFORMATION

PRINCIPALS OF THE COMPANY