Asset Capital Leasing

Online Equipment Lease Application

Please complete this form to apply for a lease.
If you wish to print the form and fax it in click here. Download Form

Vendor Information (The Supplier of the Equipment)
Vendor Name:
Address:
City, State (Prov), Zip (Postal Code):
Contact Name:
Phone Number:
Fax Number:
Email:
Lessee Information (The User of the Equipment)
Company Name:
DBA:
Federal Tax ID:
Address:
City, State (Prov), Zip (Postal Code):
Contact Name:
Contact Title:
Phone Number:
Fax Number:
Email Address:
Web Site:
Nature of Business:
Business Structure:	Select Proprietorship Partnership Non-Profit Corporation
Years In Business (Under Present Ownership):
Equipment Description:
Equipment Cost:
Indicate Currency: US or Canadian Funds	US Funds Canadian Funds
Lease Term:	Select 12 Months 24 Months 36 Months 48 Months 60 Months
Purchase Option:	Select One Dollar FMV 10 Percent
Monthly Payment:
Bank References ( Financial statements for the last two years are required for transactions over $25,000)
Bank Name:
Address:
City, State (Prov), Zip (Postal Code):
Contact:
Phone Number:
Fax Number:
Account Type:
Account Number:
Trade Reference # 1
Company Name:
Address:
City, State (Prov), Zip (Postal Code):
Contact:
Phone Number:
Fax Number:
Trade Reference # 2
Company Name:
Address:
City, State (Prov), Zip (Postal Code):
Contact:
Phone Number:
Fax Number:
Personal Data ( Guarantor information required for all proprietors, partnerships, and closely held corporations)
Name:
Home Address:
City, State (Prov), Zip (Postal Code):
Social Security Number: or SIN :
Name:
Home Address:
City, State (Prov), Zip (Postal Code):
Social Security Number:
Additional information that could help in the evaluation of my application:
Is this a lease back or new purchase.
This application is being submitted by:	Select Lessee Vendor on Behalf of Lessee
All correspondence should be sent to:	Select Lessee by Fax Lessee by Email Vendor by Fax Vendor by Email
Your Email Address (Required):

REQUIRED: YOU MUST SELECT "I Agree" FROM THE DROP-DOWN MENU LISTED BELOW BEFORE YOUR APPLICATION CAN BE PROCESSED.  IF YOU DO NOT MAKE A SELECTION OR YOU SELECT "I Do Not Agree" YOUR APPLICATION WILL NOT BE PROCESSED.

I Agree I Do Not Agree -Select-  By submitting this application, I certify that all the information I have given or will give with this application is true and complete.  I hereby give you the authorization to obtain information concerning my personal and/or company credit information. 

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

 

NOTICE: IF YOUR APPLICATION FOR BUSINESS CREDIT IS DENIED, YOU HAVE THE RIGHT TO A WRITTEN STATEMENT OF THE SPECIFIC REASONS FOR DENIAL.  TO OBTAIN THIS STATEMENT, PLEASE CONTACT THE LESSOR NAMED HEREIN WITHIN 60 DAYS FROM THE DATE YOU ARE NOTIFIED OF OUR DECISION.  WE WILL SEND YOU A WRITTEN STATEMENT OF THE REASONS FOR THE DENIAL WITHIN 30 DAYS OF RECEIVING YOUR REQUEST FOR THE STATEMENT.

THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICATIONS 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 CONCERNING THIS CREDITOR  IS THE FEDERAL TRADE COMMISSION, ECOA COMPLIANCE, WASHINGTON, DC 20581.

 

 

Asset Capital Equipment Leasing