Lease Application

To apply please fill out the form below. If you have any questions, don't hesitate to contact us.
* If you prefer to fill out the application via word or pdf feel free to email or fax us the completed application.

Business Information

BUSINESS NAME/LESSEE
TELEPHONE NO.
ADDRESS (STREET, CITY, STATE, ZIP)
EMAIL ADDRESS
FAX NO.
TYPE OF BUSINESS
DATE ESTABLISHED
FED. TAX NO.
LOCATION OF EQUIPMENT (STREET, CITY, STATE, ZIP)
COUNTY

Ownership

BUSINESS STRUCTURE
Corporation    Partnership    Proprietorship
PRINCIPAL'S NAME
TITLE
% OWNERSHIP
HOME PHONE NO.
ADDRESS (STREET, CITY, STATE, ZIP)
OWN    RENT
PRINCIPAL'S NAME
TITLE
% OWNERSHIP
HOME PHONE NO.
ADDRESS (STREET, CITY, STATE, ZIP)
OWN    RENT
PRINCIPAL'S NAME
TITLE
% OWNERSHIP
HOME PHONE NO.
ADDRESS (STREET, CITY, STATE, ZIP)
OWN    RENT

Bank Reference

BANK
ACCOUNT NO.
TELEPHONE NO.
CONTACT PERSON
BANK
ACCOUNT NO.
TELEPHONE NO.
CONTACT PERSON

Insurance Information

BUSINESS INSURANCE AGENT
TELEPHONE NO.
FAX

Trades

COMPANY NAME ACCOUNT NO. TELEPHONE NO. CONTACT PERSON

Equipment Information

VENDOR
CONTACT
ADDRESS (STREET, CITY, STATE, ZIP)
TELEPHONE NO.
EQUIPMENT TO BE LEASED
COST OF EQUIPMENT
$
TERMS OF LEASE
RATE/MO. PAYMENT
DEPOSIT REC'D
$

By initialing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal of extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/We affirm my/our identity as the respective individual(s) identified in the above application.

By initialing and submitting this application, I hereby authorize Ascente Financial or any credit bureau or other investigative agency employed by Ascente Financial to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my credit and financial responsibility.

INITIAL HERE