Business Credit Application

Lessee Business Information :
Business Name: ...... Type of Entity:
Business Address:
Business City: State: Zip:
Business Phone: ... Email:
Time in Business: Fed Tax ID :
Contact Name:
Contact: Phone: email:
Principal Owner Information :
Owner Name: Social Security #: . % Own
Home Address: .Date of Birth:
Home City: State: Zip:
Home Phone: ..Cell Phone:
.Email:
Principal Owner (2) Information :
Owner 2 Name: Social Security Num: % Own
Owner 2 Home Add: .Date of Birth:
Owner 2 Home City: State: Zip:
Owner 2 Home Phone: Owner 2 Cell Phone:
Email:
Dealer Information :
Dealer Name:

.... Dealer Code:
If no dealer, enter NONE.

Dealer Address:
Dealer City: State: Zip:
Dealer Contact:
Dealer Phone: .... Dealer Email:
Equipment Information :
Equipment Description:

New or Used?
(Attach list if necessary)

Manufacturer: Model: Year:
Equipment Cost: ...Term Requested:
Notes: ...........

RELEASE & AUTHORIZATION
I (we) authorize and request you to release information concerning my personal or business credit standing for this Credit Application, any renewals or future extensions of credit, or for review or collection of any resulting account. I authorize Capital Leasing Solutions, to share any such credit reports with its affiliates, assignees and potential funding partners.

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Credit Disclosure Administrator, Capital Leasing Solutions 813 SE 2nd Court, Ft. Lauderdale, FL 33301 or phone (954) 522-3773, within 60 days from the date you are notified of our decision.

Phone: 954-522-3773

email: credit@capital-leasing.com

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