EQUIPMENT LEASING APPLICATION

BUSINESS APPLICANT 
COMPANY NAME                     D.B.A. NAME, IF ANY 

CONTACT          DATE          ADDRESS 

CITY             STATE           COUNTY           ZIP 

PHONE NUMBER     EQUIPMENT LOCATION ADDRESS 

CITY              STATE           COUNTY           ZIP 

FAX NUMBER       TYPE OF BUSINESS         DATE EST. 

YRS/CURR. OWNERSHIP   FED TAX ID#  

STRUCTURE OF OWNERSHIP:  PROPRIETORSHIP PARTNERSHIP 
CORPORATION CLOSELY HELD SUB CHAPTER PUBLIC 

LANDLORD NAME         PHONE NUMBER         YRS/CURR. OWNERSHIP 

# OF EMPLOYEES        INSURANCE AGENT NAME AND ADDRESS 

CONTACT               PHONE NUMBER        STATE OF ORGANIZATION 

OWNERSHIP 
PRINCIPAL'S NAME      TITLE                % OF OWNERSHIP 

SOCIAL SECURITY                DRIVERS LICENSE # 

HOME ADDRESS          HOME PHONE          HOW LONG  OWN 
RENT 
SPOUSE                PRINCIPAL'S NAME    TITLE  

% OF OWNERSHIP        SOCIAL SECURITY     DRIVERS LICENSE # 

HOME ADDRESS          HOME PHONE          HOW LONG  OWN 
RENT 
SPOUSE 

BANKS/LENDER 
BANK/LENDER NAME     BRANCH               CONTACT 

PHONE NUMBER  CHECKING ACCT. LEASE 
SAVING ACCT. LOAN 
NAME ON ACCOUNT                  ACCOUNT # 

DATE OPENING     FAX NUMBER      BANK/LENDER NAME 

BRANCH                CONTACT                          PHONE NUMBER 

CHECKING ACCT. LEASE  SAVING ACCT. LOAN 

NAME ON ACCOUNT                  ACCOUNT # 

DATE OPENING     FAX NUMBER  

INST DEBT 
LENDER NAME                    ADDRESS              CONTACT 

PHONE NUMBER         LENDER NAME                    ADDRESS  

CONTACT               PHONE NUMBER 

TRADES 
COMPANY NAME          PHONE NUMBER         FAX NUMBER 



LOCATION                         ACCT # OR CONTRACT 

EQUIPMENT 
VENDOR                CONTACT              PHONE NUMBER 

EQUIPMENT DESCRIPTION (MAKE, MODEL, SERIAL #) 

TERM                  COST 

DECLARATION: 
THE INFORMATION SUPPLIED IN THIS APPLICATION AND ALL FORMS AND DOCUMENTS SUBMITTED TO SOURCE ONE CAPITAL IN CONNECTION HEREWITH IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.  I/WE HEREBY AUTHORIZE  
SOURCE ONE CAPITAL OR ANY LENDERS SOURCE ONE CAPITAL DOES BUSINESS WITH TO INVESTIGATE MY/OUR FINANCIAL RESPONSIBILITY AND CREDITWORTHINESS INCLUDING INQUIRY INTO CREDIT AGENCIES.  I/WE WILL PROVIDE ADDITIONAL INFORMATION, AS SOURCE ONE CAPITAL DEEMS NECESSARY AND REQUESTS INCLUDING, BUT NOT LIMITED TO, FINANCIAL STATEMENT, TAX RETURNS,ETC. 

AUTHORIZATION 
DATE          NAME OF APPLICANT             TITLE