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(913) 381-3344

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Application for Leasing

SUPPLIER

Supplier Name Supplier Address Contact Person Supplier Phone

LESSEE

Lessee (Full Legal Name)
State of Incorporation
Contact Person
Billing Address
City
State
Zip
County Telephone Federal Tax ID  
Nature of Business

No. of Years in Business

Type of Business:                    

May we call Lessee?          


EQUIPMENT TERM RENT

Equipment Description

Equipment Cost
$

Lease Term

Monthly Rental Payments
$


ADVANCE RENTAL PAYMENT

Check ONE only:

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REFERENCES (Important to establish any loan history and highest trade references)

Bank Reference - Two Year History

   Officer to Contact:

Telephone:

Checking Acct. No.:    Loan Acct. No.:

 

   Officer to Contact:

Telephone:

Checking Acct. No.:    Loan Acct. No.:

 

Trade Reference and Previous Leases – D&B Rating

    Contact:

Telephone:

 

    Contact:

Telephone:


PERSONAL DATA

    Title:

Telephone:         SSN:


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