Lease On-Line Application

LESSEE (applicant's full legal name. Registered name.)

ORGANIZATION / BUSINESS / SCHOOL NAME
DBA
FED. TAX I. D. NO. (or SS# if SOLE PROP.)		TAX EXEMPT?
		YES       NO
ADDRESS
ADDRESS 2
CITY	STATE		ZIP CODE
PROPOSED EQUIPMENT ADDRESS (if different from above)
ADDRESS
ADDRESS 2
CITY	STATE		ZIP CODE
COMPANY CONTACT

FIRST NAME	MIDDLE	LAST NAME
TITLE	EMAIL (If Any)
PHONE	FAX
Check one for Notification of Credit Decision FAX            PHONE         EMAIL

STRUCTURE OF ORGANIZATION	STATE OF ORGANIZATION
Public School Private School Governmental Entity Proprietorship L.L.C. L.L.P. C Corporation S Corporation Partnership, General Non-Profit	-------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticat Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregan Pennsylvania Rhode Island South Carolina South Dekota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
TYPE OF ORGANIZATION	YRS. OF OPERATION
D & B NUMBER	YEARS UNDER PRESENT MANAGEMENT

LEASE PROGRAM
TERM	NUMBER OF YEARS
Monthly Quarterly Annually	1 Year 2 Years 3 Years 4 Years 5 Years

EQUIPMENT / SOFTWARE
Description of equipment and/or software to be purchased.
Estimated Purchase   $
SCHOOLS AND OTHER GOVERNMENTAL ORGANIZATIONS CLICK HERE TO CONTINUE. GRAYED BOXED AREA SHOULD ONLY BE FILLED OUT BY BUSINESS. GUARANTORS

OWNER/OFFICER FIRST NAME	OWNER/OFFICER LAST NAME	SOCIAL SECURITY NUMBER
ADDRESS	ADDRESS 2	HOME PHONE
CITY	STATE	ZIP CODE
	-------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticat Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregan Pennsylvania Rhode Island South Carolina South Dekota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
OWNER/OFFICER FIRST NAME	OWNER/OFFICER LAST NAME	SOCIAL SECURITY NUMBER
ADDRESS	ADDRESS 2	HOME PHONE
CITY	STATE	ZIP CODE
	-------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticat Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregan Pennsylvania Rhode Island South Carolina South Dekota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
OWNER/OFFICER FIRST NAME	OWNER/OFFICER LAST NAME	SOCIAL SECURITY NUMBER
ADDRESS	ADDRESS 2	HOME PHONE
CITY	STATE	ZIP CODE
	-------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticat Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregan Pennsylvania Rhode Island South Carolina South Dekota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

BANK REFERENCES
#1 BANK NAME	CONTACT NAME	ACCOUNT #	PHONE NUMBER
#2 BANK NAME	CONTACT NAME	ACCOUNT #	PHONE NUMBER
TRADE REFERENCES
#1 TRADE REFERENCE	CONTRACT NAME	ACCOUNT #	PHONE NUMBER
#2 TRADE REFERENCE	CONTRACT NAME	ACCOUNT #	PHONE NUMBER