Phone
# (913) 894-4979Phone
# (913) 894-4979Lessee Important to set out the full legal name of company
Company Name_______________________________________________________________________________________________________________________
Billing Address________________________________________________________________________________ Tax I.D. Number_________________________
City_______________________________________County_____________________State_____________________________Zip___________________________
Nature of Business__________________________________________Telephone_________________________________No. of Years in Business______________
Type of Business: ____ Non- Profit ____ Proprietorship ____ Partnership ____ Corporation No. of Employees_________________________________
Personal Information On officers, Partners, or Guarantors
1.) Name____________________________________________________Title____________________Social Security No._______________________________
HomeAddress_________________________________________________City____________________________State_____________Zip____________________
2.) Name ______________________________________________________Title____________________Social Security No._______________________________
HomeAddress_________________________________________________City____________________________State_____________Zip____________________
By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application. A $300 processing fee will be charged in addition to the purchase and delivery cost.
Equipment TO BE LEASED Attach a separate list if necessary
Qty. Serial# Description Cost
Type of Lease ( Circle One ) Type Of Lease ( Circle One )
24 36 48 60 5% Buy Out 10% Buy Out 15% Buy Out FMV Buy Out $101 Buy Out
TRADE REFERENCES Important to establish high credit and good payment history
Name of Supplier_____________________________________City/State___________________Telephone_________________________Contact______________
Name of Supplier_____________________________________City/State___________________Telephone_________________________Contact______________
Name of Supplier_____________________________________City/State___________________Telephone_________________________Contact______________
LEASE AND LOAN REFERENCES Six month pay history
Lender____________________________Original Amount_________________Account No._________________Telephone________________Contact__________
Lender____________________________Original Amount_________________Account No._________________Telephone________________Contact__________
COMPANY BANK REFERENCES Must have two year history
Name of Bank/Branch____________________________________________________How long____________________Telephone__________________________
Checking Acct. No.______________________________________________________Loan Acct. No.___________________________Contact_________________
Name of Bank/Branch____________________________________________________How long____________________Telephone__________________________
Checking Acct. No.______________________________________________________Loan Acct. No.___________________________Contact_________________
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. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, D.C. 20580.
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 Lessor set forth above 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. By signing below, you certify that the statements above and on any attachments are true and complete as of the date given below. You authorize The Hanna Group and any or all other leasing or financing entities or agents to investigate applicant�s credit worthiness as may be needed. The undersigned authorizes all banking institutions, credit reporting agencies and its agent to release all necessary information, for the purpose of securing a lease.
Customer Signature____________________________________Customer Name______________________________________Title/Date___________________
Customer Signature____________________________________Customer Name______________________________________Title/Date___________________