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ONLINE CREDIT LEASE APPLICATION
Business Legal Name (and DBA if applicable)
Street Address
City
State
Zip
Phone
Fax
Type of Business
State of Incorporation
Time In Business under Current Ownership
Federal ID Number
Type of Ownership
PRINCIPAL INFORMATION
(100% Ownership disclosure required. Principals listed will be required to guaranty lease.)
Officer's Name
Title
Ownership %
Social Security #
Present Address
City
State
Zip
Home Phone Number

Officer's Name
Title
Ownership %
Social Security #
Present Address
City
State
Zip
Home Phone Number
BANK/CHECKING & SAVING
(If check acct. less than 2 years; provide previous acct. number/bank)
Bank Name
Phone
Fax
Officer
Account Number
How Long
Account Type

Bank Name
Phone
Fax
Officer
Account Number
How Long
Account Type
EQUIPMENT LOANS/LEASES (Open or Paid)
Firm Name
Phone
Fax
Contract/Account Number
High Credit
How Long
TRADE REFERENCES
Firm Name
Phone
Fax
Contract/Account Number
High Credit
How Long

Firm Name
Phone
Fax
Contract/Account Number
High Credit
How Long
EQUIPMENT TO BE LEASED
Vendor Name
Contact
Phone
Equipment Description
Equipment Cost
Is Equipment:
If Used, How Old?
Equipment Location
(if other than above)
Term Requested:
AUTHORIZATION
By authorizing below, each undersigned individual(s) who is either a principal of the credit applicant listed above or a personal guarantor of its obligations, provides written instruction to WASCO Capital Services, LLC or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purposes of update, renewal or extension of such credit and for reviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original.
I hereby authorize our banks, trade references, and financial institutions the right to release credit information.
Name
Title
Date
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