Application for Equipment Funding – JKaiser Workspaces LLC

EXACT NAME OF COMPANY*

STRUCTURE OF COMPANY

Corporation

L. L. C.

Partnership

Proprietorship

INDICATE STATE:*

FED. I.D. No.

How long has this business been open?*

How long by this owner?*

How long at this address?

How did you hear about Lease$mart?*

Contact Person*

Business Phone*

FAX Number

YOUR Email*

Business Address*

City*

County*

State*

Zip Code*

Describe your business here:

Your website address (url)

Owners/Officers/Partners Full Names

Title

Own %

Home Address & Zip Code

Home Phone

SSN

Biz Banking References, Branch

Officer

Phone

Account #

Checking

Savings

Loan

Checking

Savings

Loan

Checking

Savings

Loan

Other Leases - Active

Contact

Phone

Account #

Equipment Leased

Insurance Carrier Providing Coverage

Agent Name

Phone

Address including city, ST ZIP

Help us to justify funding your acquisition. Briefly DESCRIBE/QUANTIFY HOW MUCH ($$$/month or $$$$/year) the leased item(s) will benefit your company.
Example: "We will add a new service, bringing in $X,XXX new revenues/month" or
Example: "New machine will allow 1 employee to do what currently takes 2 people 8 hours. Savings: $XX,XXX + per year"

Describe/List the equipment to be leased

Urgency: How soon do you plan to complete this acquisition?

Immediately

Within 30 days

Between 30 to 90 days

Undetermined/Just shopping

Location/physical address where equipment will be kept and used

Equipment Supplier/Vendor for this lease

Contact name(s)

Phone:

Check here if multiple vendors.

Vendor Address

Approximate Price of Equipment*

Lease Term Requested

Lease-end Purchase Option Requested

Comments

Note: After you click the 'Submit' button below, you will be requested to PRINT AND SIGN a credit release form and then fax or mail it to us with some additional information. Please read and follow the detailed instructions on the next page (after you click the 'Submit' button). Thanks!

Call Lease $mart with application or credit questions or if you need assistance with this application.
800-532-7303 (800-LEASE03).

By clicking on the 'Submit Application' button above, the undersigned individual, who is either a principal of the above-named business credit applicant or a personal guarantor of its obligations, provides specific authorization to Lease$mart and its assigns (and any assignee or potential assignee thereof) for review of his/her personal credit profile from any national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. By clicking on the 'Submit Application' button above, I/we affirm my/our identity as the respective individual/s identified in the above application.