Equipment Lease \ Loan Application

Print this application, sign it and fax it to 1-727-585-1316
We will be in contact with you within 24 hours.


(Click file, then print or Ctrl p on your keyboard)

LESSEE:

Legal Full Name:

D.B.A.:

Address:

Phone:

City:

State:

Zip:

Fax:

Country:

Years in Business:

Type of Business:

 

City Limit Y/N

CORP

PROP

PTSHIP

1. Officer Name:

Title:

% Ownership:

Street:

DOB:

SS#

City:

State:

Zip:

2. Office Name:

Title:

% Ownership:

Street:

DOB:

SS#

City:

State:

Zip:

EQUIPMENT:

Description:

New Used

Location if different from above:

Total Price without Tax:$

Lease Term (Months)

Monthly Payment:$

Sales Tax Rate:

% No. Advance Rentals:

BANKS:

Make sure you provide a two year banking history. If your present bank account is less than two years old, please provide bank information, including account number even if account is closed now. We MUST be able to track your banking history for a minimum of two years.

Name:

Phone:

Account #:

Account Type:

Officer Name:

Prev. Bank Name:

Phone:

TRADE REFERENCES AND OTHER ACTIVE LEASES:
(With Comparable Borrowing)

Provide two trades with high credit and long term relationship. One lease or loan reference is preferred.

Name:

Phone:

Contact:

Account#:

Name:

Phone:

Contact:

Account#:

Lease or Loan:

Phone:

Contact:

Account#:

VENDOR:

Name: Chassis King, LLC

Phone: 727-585-1500

Fax: 727-585-1316

Address: 1016 Ponce DeLeon Blvd.ive

City: Clearwater

State: FL

Zip: 33756

Contact: Donald Pratt

The undersigned certifies that the above information given for credit purposes is true and correct and authorizes the firm or person to whom this application is made and credit bureau agency to investigate the references, statements or other data listed or accompanying this application. The undersigned authorizes all parties contracted to release credit and financial information requested as a part of an investigation. (photocopy of this application may be presented as evidences of authority also.)

Lessee Signature: X

Title:

Date: