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Business Name
*
*
Indicates required field
Year Started
*
Year Incorporated
*
Annual Sales Gross $
*
Federal I.D.
*
Name
*
First
Last
Business Address
*
Line 1
Line 2
City
State
Zip Code
Country
Equipment Location
*
Landlord Contact Info
*
Monthly Rental $
*
Business Phone Number
*
Business Fax Number
*
Borrower is (Check One)
*
Individual
Proprietorship
LLP
LLC
Partnership
S-Corp
Purpose (Check One)
*
Replacement
Expansion
1. Owner Name (same as borrower if individual)
*
First
Last
Owner's Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Owner's Email
*
% owned
*
Owner's Title
*
Owner's Social Security Number
*
Owner's Home Phone Number
*
Owner's Cell Phone Number
*
2. Owner Name (Co-Signer)
*
First
Last
(Co-Signer's ) Address
*
Line 1
Line 2
City
State
Zip Code
Country
(Co-Signer's) Email
*
% owned
*
(Co-Signer's) Title
*
(Co-Signer's) Social Security Number
*
(Co-Signer's) Home Phone Number
*
(Co-Signer's) Cell Phone Number
*
WORK SOURCES
Work Source Company #1
*
Type of Work #1
*
How long #1?
*
Contact Name #1
*
Phone Number #1
*
Work Source Company #2
*
Type of Work #2
*
How long #2?
*
Contact Name #2
*
Phone Number #2
*
EQUIPMENT PURCHASE INFORMATION
Condition
*
New
Used
Year
*
Make/Model
*
Selling Price (excluding tax)
*
Vendor Name
*
Trade-In Allowance
*
Vendor Phone Number
*
Mileage/Hours
*
Cash Down Payment
*
Vendor Contact
*
Make, Model/Description
PERSONAL REFERENCES
1. Nearest Relative #1
*
Relationship #1
*
Address #1
*
Phone Number #1
*
2. Nearest Relative #2
*
Relationship #2
*
Address #2
*
Phone Number #2
*
The undersigned certifies that the information contained in this financing application is true and correct and authorizes Lake Equipment Leasing, Inc. and person to whom this application is made and any credit bureau or investigative agency to investigate the information contained with this application and obtain information about the undersigned’s accounts and credit experience. 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. A photo static or facsimile copy of this authorization shall be valid as the original.
Digital Signature
*
Title
*
Date
*
Submit
