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.

ECOA Notice
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. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.

Phone: 954-522-3773

email: credit@capital-leasing.com

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