Apply

Follow these three easy steps:

1. Complete the Online Lease Application below (or Download PDF Application here)

2. Email or fax the summary page from the last three months business checking account to jimphelps@leasingdollars.com

3. Send in a quote or invoice from your vendor

Equipment Leasing Application Form

Applicant Contact Important: Enter a valid e-mail address. Correspondance will be sent to this address. Name* Phone* E-Mail:* Referral Partner Referral Partner Company* Referral Contact Name* Referral Contact Phone Number* Your Business Information Full Legal Company Name* Address Line 1:* City:* State:* Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* County:* Business Phone:* Fax Number:* Cell Phone: Type of Business:* Type of Ownership* Corporation LLC Partnership Sole proprietor Government Non-Profit Federal Employer Identification Number(EIN)* Business Established Date* Time in business under current ownership* Nature of Business Number of Employees* Tax Exempt* Yes No Location of Equipment Please list all Owners and/or Shareholders with higher than 10% ownership in the business. Name* Title* Home Address* Phone* Identification No.* Name Title Home Address Phone Identification No. Name Title Home Address Phone Identification No. Name Title Home Address Phone Identification No. Vendor and Equipment Information Amount Requested in $ Equipment Description Vendor Company Name Preferred Lease Term Choose a Preferred Lease Term12 months24 months36 months48 months60 months Purchase Option Choose a Purchase Option10%$1.00EFA Sales Representative`s Name Sales Reps Phone ###-###-#### Sales Reps Email name@email.com Guarantor Information Principal Full Name:* Title Choose a TitleCEOCOO Ownership Percentage:* Home Phone Number:* Home Address (Street):* Home Address (City):* State:* Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* Social:* Comments* Secondary Full Name:* Title Choose a TitleCEOCOO Ownership Percentage:* Home Phone Number:* Home Address (City):* State:* Choose a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* Social: Comments Bank Reference Bank Name* Contact Person:* Phone:* Fax:* Account Type Account Number: How Long open?: Acceptance I agree to furnish current financial statements?* Yes No I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE IT`S VERIFICATION AND THE OBTAINING OF A CREDIT REPORT. I understand any false or misleading statements in my application may cause any loan to be in default. I agree that this application shall be this Institutions`s property whether or not this credit application is approved. By entering my first & last below, I stipulate that I agree to all of the terms and conditions stipulated on this application. Signature:* Title* Dated:* Enter your first and last name in the signature space above. Reset Powered by Elbowspace.com