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Either Fill out the information and press the "Send It!" button or:

Print out this page, fill it out with a black pen & fax it to (714)921-9107.  (Please leave us a phone number where we can get through to you during normal business hours.)

Please provide the following contact information:

  Contact Information
  Your first name Your last name
   
  Title
 
  Street address #1
 
  Street address #2
 
  City State
   
  ZIP  
   
  Phone FAX
   
  E-mail
 
 
  Business Profile
  Legal Business Name  
  Doing Business as  
  Business' Main Phone Number  
   
  Nature of  business (e.g. construction, agro, medical)
 
  Business type  
 
  Number of Partners/Shareholders  
  Tax Status Years in business
   
   
 
  Privately Owned Business
  Please complete this section only if you are a privately owned business 
  Estimated Annual Billings  
  Total Employees  
  Credit Reference Information
  - - - Owner/Officer/Partner 1 - - -
  First Name Last Name
   
  Social Security Number  
 
  - - - Owner/Officer/Partner 2 - - -  
  First Name Last Name
   
  Social Security Number  
 
  - - - Owner/Officer/Partner 3 - - -  
  First Name Last Name
   
  Social Security Number  
 
 
  Equipment Specifications
  Manufacturer  
  Product name  
  Model Number  
  Quantity  
  Estimated Acquisition Time  
  Comments
 
   
 
  Equipment Cost Worksheet
  Round to nearest hundred dollars and omit commas (e.g. 82,556 = 82600).
  Equipment cost  
  Sales Tax  
  Shipping Charges  
  Sub-total  
  Installation cost  
  Total equipment cost  
 
  Preferred Lease Terms
  Term  
  End of Lease Option  
  Target Lease Payment (monthly)  
  Special Lease Features  
     


By clicking the SUBMIT button below, Applicant represents that he/she is authorized to make application for the related business enterprise or individual(s) named in the lease financing application and that he/she has read and understands the attached LeasingShop.com LEASE FINANCING APPLICATION TERMS AND CONDITIONS which include but are not limited to granting LeasingShop.com and its Lenders permission to gather credit information on the business enterprise and/or its principal officers named in the lease financing application.


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