BargainLease.com: Fill out our application form and be on your way to financing equipment for your company, or leasing and selling equipment through our Vendor Program!

Business Legal Name (and any DBA if applicable):
Federal Tax Number:
Street
City, State, Zip:
Phone Number:
Fax Number:
E-mail:
Type of Business:
Business Description:
Years Under Current Ownership:
PERSONAL INFORMATION ON OFFICERS, PARTNERS, OR OWNERS
Name:
Home Address:
City, State, Zip:
Social Security Number:		- -
Percentage of Ownership:		%
Name:
Home Address:
City, State, Zip:
Social Security Number:		- -
Percentage of Ownership:		%
BANK REFERENCES
Bank Name:
Phone Number:
Contact Person:
Account Number:
LEASE/LOAN REFERENCE
Bank Name:
Phone Number:
Contact Person:
Account Number:
BUSINESS TRADE REFERENCES
Supplier #1
Supplier Name:
Phone Number:
Contact / Account Number:
Supplier #2
Supplier Name:
Phone Number:
Contact / Account Number:
Supplier #3
Supplier Name:
Phone Number:
Contact / Account Number:
EQUIPMENT INFORMATION
Description:
Cost (without tax):
Address of Installation:
VENDOR INFORMATION
Company Name:
Address:
City, State, Zip:
Contact Name:
Contact Telephone:
PROPOSED LEASE TERMS
Amount:
Purchase Option:
Number of Months:
Monthly Payment (without tax):
By submitting this form, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its Designee ( and any assignee or potential assignee thereof ) authorizing review of his / her personal credit profile from a 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. A Photostat or facsimile copy of this authorization shall be valid as original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application. I also authorize my bank and trade references to release all information as requested by Indigo Leasing Services or its assignees. This information can either be released by telephone or by facsimile transmission.