HTML Preview Equipment Lease Application page number 1.
Equipment Lease Application
Please send completed application via e-mail to
or fax to 203.549.0476
Customer Information
Business Legal Name: DBA Name (if any):
Street Address: Federal Tax ID:
City/State/Zip Code: Date Business Started:
Phone: Fax: E-Mail:
Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Other:
Bank Name: Checking Account #: Phone #: Contact Name:
Principal Information
Principal Name(s), Title(s): 1. 2. 3.
Home Address:
City/State/Zip Code:
% Ownership:
Social Security #:
Signature:
Authorization
Signature of Applicant: Date:
Credit Release
lender or any other lending sources to obtain information from the references listed below and obtain a consumer credit report that will be ongoing and relate not only
to the evaluation and/or extension of the business credit requested, but also for purposes of reviewing the account, increasing the credit line, taking collection action
on the account and for any other legitimate purpose associated with the account as needed. Each individual signing as principal further waives any right or claim which
such individual would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent.
Lease/Loan References
Name of Reference: City/State Phone Contact Account #
Equipment Information
Vendor: Vendor Contact Name & Phone:
Equipment Description:
Equipment Cost: Term: Term Option: FMV $1.00 Out 10% Option 10% PUT
220 Kinderkamack Road, Suite B
Westwood, NJ 07675
45 Main Street, Suite 537
Brooklyn, NY 11201
457 Castle Avenue
Visit us online at www.gsgfinancial.com