3824 N. Hullen St. Metairie, Louisiana 70002
504-454-2229   FAX 504-454-2025   800-324-3040

"A Company Big Enough to Serve You and Small Enough to Care"

EQUIPMENT LEASE PURCHASE APPLICATION

"Your Information is Kept Strictly Confidential!"

COMPANY INFORMATION


(R) - Required Information

COMPANY NAME (R)

Phone (R)

Corporate Name
   ( If Corporation ) (R)

Billing Address
 (R)

City (R) State (R)

ZIP (R)

Equipment location (R)
  (If other than billing address)


Years in business (R)

Nature of business (R)

FEDERAL TAX ID# (R)


Type of Business (R)


Sole Proprietorship     Partnership

Corporation               Other

BANK REFERENCES


Bank Name (R)
                 
Bank Phone (R) Acct No (R)

Bank Officer Name (R)

Type of Acct (R)   Business Personal

Bank Name

Bank Phone Acct No

Bank Officer Name

Type of Acct   Business Personal

TRADE REFERENCES

1) Trade Reference (R)    

      Phone no (R) Acct no (R)

2) Trade Reference (R)

     Phone no  (R) Acct no (R)

3) Trade Reference

     Phone no Acct no

EQUIPMENT VENDOR INFORMATION


Vendor name (R)

Vendor Contact (R)

Phone (R) 

Equipment cost without sale tax (R)

Term of lease: (R)

13 Months 24 Months 36 Months
48 Months 60 Months


Purchase Option (R)

$1.00 Buyout     Fair market value

LIST EQUIPMENT

Item
# 		Quantity (R) Equipment Description (R)
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
(fax or e-mail separate list if more room needed)

FOR SOLE OWNERSHIP, PARTNERSHIPS, CLOSE    CORPORATIONS


  Principal's Name (R)

  Principle's SSN (R)  Phone No (R)

  Principle's title (R)

Principle's home address: (R)

Press to generate
lease application form.

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