You will need the information listed in the left pane to complete this application. (Estimated time to complete form: 20 mins)
LESSEE APPLICANT INFORMATION
Complete Legal Name for Business Federal ID Billing Address (and physical address if P.O. Box) City State, ZIP Telephone (000)000-0000 Fax (000)000-0000 Contact Person Title Type and Brief Description of Business Years in Business/Years at Location No. of Employees
Business Type (choose one) Corporation Partnership Proprietorship
OWNERS/OFFICERS INFORMATION Full Name Title % Ownership Home Address Social Security Number 000-00-0000
Full Name Title % Ownership Home Address Social Security Number
BANK INFORMATION
Name of Bank City, State Telephone Number (000)000-0000 Account Number Contact Officer
Name of Bank City, State Telephone Number Account Number Contact Officer
DEBT INFORMATION
Lender's Name Telephone Number (000)000-0000 Account Number
Lender's name Account Number Telephone Number
Lender's Name Account Number Telephone Number
TRADE INFORMATION
Supplier's name Telephone Number (000)000-0000 Account Number Contact Person City, State
Supplier's name Telephone Number Account Number Contact Person City, State
Supplier's Name Telephone Number Account Number Contact Person City, State
EQUIPMENT
Supplier Address Telephone Equipment Location (if not same as business address) Equipment Description Condition of Equipment New Used Price: Tax: Total:
Term of Lease (in months) 36 48 60 72
Comments:
Click submit or print form and email to: ljennings@amstatcapital.com (321)452-4459
