COMMERCIAL EQUIPMENT LEASE APPLICATION
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C apital $ources, Inc. (Phone: 816-246-6740)704 N.E. Langsford Road (Toll Free: 800-264-6740) Lee’s Summit, MO 64063-2979 (Web Site:capitalsourcesinc.com) (FAX: 816-246-6736) e-mail:danpack@capitalsourcesinc.com |
VENDOR: (phone: 800-580-2376)Aero Express, Inc. 1825-1 S. W. Market St. Lee's Summit, MO 64082 CONTACT: Jeanne Rau |
APPLICANT INFORMATION
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BUSINESS LEGAL NAME (AND ANY DBA, IF APPLICABLE) |
TYPE OF BUSINESS |
TELEPHONE (WITH AREA CODE) | |||||
|
ADDRESS (STREET) |
(CITY) |
(STATE) |
(ZIP CODE) |
FAX NO. (WITH AREA CODE) | |||
|
CONTACT |
BUSINESS STRUCTURE (check one) o Corporation oPartnership oProprietorship |
STATE OF INCORPORATION |
YRS IN BUSINESS—DATE INCORP. |
FEDERAL I.D. NO. | |||
|
LOCATION OF EQUIPMENT (STREET) |
(CITY) |
(STATE) |
(ZIP CODE) |
(COUNTY) | |||
OWNERS / OFFICERS
|
PRINCIPAL’S NAME |
TITLE |
% OWNERSHIP |
HOME PHONE (WITH AREA CODE) |
SOC. SEC. NO. | ||
|
HOME ADDRESS (STREET) |
(CITY) |
(STATE) |
(ZIP CODE) |
o Owno Rent |
DRIVER’S LIC. NO. | |
|
PRINCIPAL’S NAME |
TITLE |
% OWNERSHIP |
HOME PHONE (WITH AREA CODE) |
SOC. SEC. NO. | ||
|
HOME ADDRESS (STREET) |
(CITY) |
(STATE) |
(ZIP CODE) |
o Owno Rent |
DRIVER’S LIC. NO. | |
BANK REFERENCES (with at least a 2-year history)
|
BANK NAME |
(CITY & STATE) |
OFFICER |
PHONE NO. (WITH AREA CODE) |
|
ACCOUNT UNDER NAME OF: |
CHECKING ACCOUNT NO. |
LOAN NO. | |
|
BANK NAME |
(CITY & STATE) |
OFFICER |
PHONE NO. (WITH AREA CODE) |
|
ACCOUNT UNDER NAME OF: |
CHECKING ACCOUNT NO. |
LOAN NO. | |
TRADE REFERENCES
|
COMPANY NAME |
ACCOUNT NO. |
PHONE NO. (WITH AREA CODE) |
CONTACT PERSON |
|
COMPANY NAME |
ACCOUNT NO. |
PHONE NO. (WITH AREA CODE) |
CONTACT PERSON |
|
COMPANY NAME |
ACCOUNT NO. |
PHONE NO. (WITH AREA CODE) |
CONTACT PERSON |
|
o LANDLORD o MORTGAGEE |
RENT OR PAYMENT AMOUNT |
PHONE NO. (WITH AREA CODE) |
CONTACT PERSON |
EQUIPMENT REQUESTED
|
EQUIPMENT TO BE LEASED | |||
|
COST OF EQUIPMENT |
TERMS REQUESTED |
RATE/MO. PAYMENT |
DEPOSIT RECEIVED |
PENDING LEGAL ACTION FILED AGAINST APPLICANT OR PRINCIPAL?
oYES oNO IF YES, EXPLAIN.___________________APPLICANT OR PRINCIPAL FILED BANKRUPTCY OR ASSIGNMENT TO CREDITORS IN LAST SEVEN YEARS?
oYES oNO_____AUTHORIZATION
Lessee represents and warrants that all credit and financial information submitted to Lessor is true and correct and Lessor may obtain any information necessary pertaining to this application including, but not limited to, owners, officers or guarantors. Lessee agrees to furnish financial statements to Lessor on request. Further, I authorize all banks and trade references to release information by phone or FAX to C$I or its nominees.
LESSEE: ____________________________________________
by:__________________________________________________
Title:________________________________________________
Print Name:__________________________________________
Date:________________________________________________