Online Lease Application

Company Information:
Legal Business Name: Address:
City, State, Zip: County:
Contact Person: Phone:
Email: Fax:
Business Type: Years in Business:
Federal Tax ID #:    


Personal Information:
Officer Name: Title:
Address: City, State, Zip:
SSN: % Ownership:
Phone:    

 
Officer Name: Title:
Address: City, State, Zip:
SSN: % Ownership:
Phone:    


Equipment Information:
Amount: Term:
Payment: New/Used:
Equipment Location: Years at Location:
 
Equipment Description:


Bank References:  Bank should be at least two (2) years old. If less, please supply a previous bank reference
Bank: Contact:
Business Chk Acct#: Phone:
 
Bank: Contact:
Business Chk. Acct#: Phone:


Trade References:
Main Supplier: Contact:
Account #: Phone:
 
Other Supplier: Contact:
Account #: Phone:


Landlord and Insurance Information:
Landlord for Equip Location: Contact:
City/State: Phone:
 
Busines Insurance Co.: Contact:
Prop Damage & Liab?: Phone:

  I/we hereby authorize you to whom this application is made, or your agents, to investigate my/our credit worthiness and will provide financial statements, tax returns, etc., as you deem necessary. I/we agree that the security deposit and/or advance payments are not refundable unless the application is rejected by Lessor. By the execution of the lease agreement, I/we warrant that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information. Further, I/we warrant it is understood that the Lessor reserves the right to reverse any credit decision if the information contained herein is found to be incorrect, and I/we will indemnify Lynch Capital for any and all costs incurred with this application. By signing below, the undersigned individual as principal of and/or guarantor for the applicant, authorizes Lynch Capital, its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of the update, renewal, or extension of credit to the applicant or the collection of any resultant accounts. A fax or photocopy of this authorization shall be valid as the original.


Signature:   Date:  


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