| Dealer/Distributor Information |
| Vendor |
Contact: |
Vendor
Code: |
Tel: |
| Street: |
City: |
State: |
Zip: |
| Payment Plan |
|
| Terms In Mos |
Factor Used |
FMV |
$1.00 Buyout |
10% Deposit |
| Lease Payment |
Deposits/Payments: |
Other |
New Business |
FMV/10% Option |
| Equipment To Be Leased |
|
| LESSEE (Complete legal name of entity, If a
corporation, use EXACT registered corporate
name.) |
| Company: |
DBA: |
Email |
| Billing Street
: |
Billing
City: |
|
| Billing State: |
Billing County: |
Billing Zip: |
| Telephone: |
Contact Person: |
Title: |
| Nature of
Business: |
Type of
Business: |
Years in Business: |
| PERSONAL INFORMATION ON OFFICERS, PARTNERS, OR
GUARANTORS |
|
|
| TRADE REFERENCES -- TWO YEAR HISTORY |
|
|
| COMPANY BANK REFERENCES - TWO YEAR HISTORY |
|
|
|
|
