ONLINE LEASE APPLICATION
"For a printable and faxable version of this application, please CLICK HERE"
Legal name of company Company name listed on business checks

Please specify your business structure

Sole Proprietorship Partnership Corporation LLC

Business Address City State

Zip

Telephone Fax Number Date Business
Started		 Federal Tax
ID Number
Principal/Officer/Partner#1 Title Social Security
Number		 Equity/
Ownership%

Home Address City State Zip

Principal/Officer/Partner#2 Title Social Security
Number		 Equity/
Ownership%

Home Address City State Zip

Bank Institution #1

Telephone Number

Account Number

Bank Contact Person

Business or Personal

Approx/Avg Balance 6/Mo

Bank Institution #2

Telephone Number

Account Number

Bank Contact Person

Business or Personal

Approx/Avg Balance 6/Mo

Trade Reference #1 Telephone Contact Person Account Number

Trade Reference #2 Telephone Contact Person Account Number

Trade Reference #3 Telephone Contact Person Account Number

Other Equipment Leased
Last 12 Months		 Company Telephone Amount
Financed

Type of Equipment to be Financed New Used Approximate Amount

Equipment Purchased From Vendor) Contact Person Telephone Fax Number

E-Mail Address Who Referred you
to our Web-Site		 Telephone Number or
E-Mail of Referral

By submitting this application electronically you hereby authorize all financial institutions, trade references, and credit bureaus (personal and business) to release credit information to North American Capital, its partners, legal representatives, and/or its assignees for consideration of requested lease application above.