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BUSINESS LEASE CREDIT APPLICATION
Equipment Supplier:
Term Requested:
*
12 Months
24 Months
36 Months
48 Months
60 Months
72 Months
Other
Amount $ (Net of taxes)
*
Contact:
*
Phone:
*
Email:
*
Equipment:
*
Equipment Status
*
NEW
USED
If used, what year is the equipment?
COMPANY INFORMATION
Business Legal Name
*
Operating As (DBA)
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP / Postal
Contact
*
First Name
*
Last Name
*
Email
*
Description of Business
*
Federal ID Number (US Only)
Business Structure
*
Incorporated
Partnership
Proprietorship
LLC
Other:
Other Value
Business Start Date
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Location of Equipment
*
Same as Above
Different
Actual Equipment Location (If different)
Address Line 1
Address Line 2
City
State/Province
ZIP / Postal
Insurance Broker:
Contact
First Name
Last Name
Phone
Landlord:
Contact
First Name
Last Name
Phone
PRINCIPALS OF THE COMPANY
Legal Name
*
First Name
*
Last Name
*
Title
*
% Ownership
*
SIN/SSN
*
Date of Birth
*
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Month
01
02
03
04
05
06
07
08
09
10
11
12
Day
01
02
03
04
05
06
07
08
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11
12
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16
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18
19
20
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22
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24
25
26
27
28
29
30
31
Year
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
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23
24
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
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Month
01
02
03
04
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09
10
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Day
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Year
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24
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
*
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Year
24
Authorized Signature
*
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Name
First Name
Last Name
Title
Date
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Authorized Signature
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