Secure Lease - Credit Application

You may use this Secure online form to submit an application for our review.

A COMPLETE AND ACCURATE APPLICATION WILL ENABLE US TO PROVIDE YOU WITH A QUICK DECISION!*

STEP 1 - Please Tell Us About Your Company
What is the name of your business?
Is the business a: Corporation LLC Partnership Proprietorship
What is the street address?		What is the City?
Which State?		Zip Code?
What is the Phone number?		What is the FAX number?
How long has this business been established under present management?
Please describe the nature of your business:
Who may we contact for further information?
What is the contact's email address?
STEP 2 - Please Tell Us About the Equipment You Want To Lease
Please give us a brief description of the equipment you plan to lease:
What is the approximate cost of the equipment?
Who will be the Dealer for the equipment(if known)? Dealer Name:
Which Leasing term would you like? 36 months 48 months 60 months
STEP 3 - Please Tell Us About the Principal(s)/Guarantor(s)
Principal #1		Principal #2
Name:		Name:
Home Address:		Home Address:
City, State, Zip:		City, State, Zip:
Social Security Number:		Social Security Number
Title:		Title:
Percentage of Stock Ownership:		Percentage of Stock Ownership:
STEP 4 - Please Give Us Your Bank Information
Where do you keep your business bank account?
Bank Telephone Number:		Bank Account Number:
Bank Officer/Contact:		How long has this account been open?
STEP 5 - Please Tell Us About Any Comparable Business Credit
Name:		Telephone Number:
Contact Person:		Account Number:
STEP 6 - Please Give Us Some Trade Reference Information
Reference #1	Reference #2		Reference #3
Business Name:	Business Name:		Business Name:
Phone Number:	Phone Number:		Phone Number:
Contact Person:	Contact Person:		Contact Person:
STEP 7 - Please Review Your Answers and Submit This Application

*I, the above signed applicant, hereby authorize any bank, financial institution, or any other financial creditor with whom I currently maintain accounts, or have maintained accounts in the past, to release any and all account details (including pay history, collateral, and current status) to the lessor, and its assigns and/or successors, as the situation may warrant. I also authorize the lessor, and/or its assigns or successors, to verify information and to obtain personal, consumer, and/or business credit reports. A photostat or facsimile copy of this authorization shall be valid as the original.

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 legal 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 concerning this creditor is the Federal Deposit Insurance Corporation, Suite 1600, One Atlantic Center, 12012 West Peachtree Street, N.E., Atlanta, GA 30309-3449. If your application for credit is declined, you have the right to a written statement of the specific reason(s) for the denial. If you wish to receive that statement, please write to: Commercial Credit, P.O. Box 15456, Fort Wayne, IN 46885 within 60 days from the date you are notified of the credit decision. We will send you a written statement of the reason(s) for the denial within 30 days of receiving your written request.