North American Funding LEASE
APPLICATION
7281 Lone Pine Dr.,
Suite. D-201 - Rancho Murieta, CA 95683
Mailing Address: P.O. Box 980 - Rancho Murieta, CA 95683
916-354-3030 - FAX 916-354-1003
LESSEE COMPANY
INFORMATION
FULL LEGAL NAME O CORPORATION O NON-PROFIT TELEPHONE NUMBER
O PROPRIETORSHIP O PARTNERSHIP ( ) FAX( )
COMPANY ADDRESS CITY COUNTY STATE ZIP
SIGNER ON LEASE TITLE NATURE OF BUSINESS DATE BUSINESS STARTED
PERSONAL INFORMATION ON OWNERS, OFFICERS, PARTNERS OR
GUARANTORS
NAME TITLE PERCENTAGE OF OWNERSHIP
SOCIAL SECURITY NUMBER
HOME ADDRESS CITY STATE ZIP
HOW LONG? HOME PHONE NUMBER
NAME TITLE PERCENTAGE OF OWNERSHIP
SOCIAL SECURITY NUMBER
HOME ADDRESS CITY STATE ZIP
HOW LONG? HOME PHONE NUMBER
COMPANY BANK REFERENCES - TWO YEAR HISTORY
NAME OF BANK - BRANCH
HOW LONG? TELEPHONE NUMBER CONTACT OFFICER
BUSINESS CHECK AND/OR LOAN
ACCOUNT NUMBER(S)
NAME OF BANK - BRANCH
HOW LONG? TELEPHONE NUMBER CONTACT OFFICER
BUSINESS CHECK AND/OR LOAN
ACCOUNT NUMBER(S)
COMPANY TRADE
REFERENCES - TWO YEAR HISTORY
NAME OF
SUPPLIER CITY/STATE TELEPHONE
NUMBER CONTACT
NAME OF SUPPLIER CITY/STATE TELEPHONE
NUMBER CONTACT
LEASE/LOAN REFERENCES: CITY/STATE TELEPHONE NUMBER
CONTACT
SUPPLIER OF
EQUIPMENT
VENDOR NAME TELEPHONE NUMBER CONTACT
VENDOR ADDRESS CITY STATE ZIP
EQUIPMENT
DESCRIPTION & TERMS REQUESTED
EQUIPMENT DESCRIPTION
INCLUDING APPROXIMATE COSTS
NUMBER OF MONTHS FOR LEASE: O 12 O 24 O 36 O 48 O 60
By signing
below, the undersigned individual, who is either a principal of the credit
applicant or a personal guarantor of its obligations, provides written
instruction to North American Funding 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 purpose 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 the original. By signature below,
I/we affirm my/our identity as the respective individual/s identified in the
above application.
Signature:
Date:
Signature: Date: