Equipment Credit Application

Business Name

Business Address

City

State / Province

Postal / Zip Code

Country

Business Phone Number

Fax Number

Business Type

Proprietorship Partnership Corporation LLC

Year formed

Years in Business

Officer 1

SS#

Title

Home Address

City

State / Province

Postal / Zip Code

State / Province

Home Number

Mobile Number

Fax Number

Email Address

Officer 2

Last Name

Social Security #

Title

Home Address

City

State / Province

Postal / Zip Code

Country

Home Number

Fax Number

Mobile Number

Vendor Name

Vendor Phone Number

Fax Number

Sales Representative

Sales Reps Mobile

Sales Reps Email

Authorization to call Lessee

Yes No

Equipment Description

QTY.

Total Price

Term of Lease (months)

Trade Credit References - Please provide at least 3 (Use trades with the longest history and the highest credit)

Reference Name

Contact

Account #

Phone Number

Checking & Lending References

Bank Name

Bus. Checking #

How many years?

Phone Number

Contact

Loan #

By clicking submit below, the undersigned individual as principal of and/or guarantor for the applicant, authorizes CL&F or its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of the update, renewal, or extension of credit to the applicant or the collection of any resultant accounts. By clicking on "Submit" this authorization shall be valid as the original.

First Name

Last Name

Date