Equipment Lease Application

Phone (310) 828-1199  Fax (310) 828-7781


BUSINESS/Company Information
Legal Business Name/d.b.a
Corporation Partner Sole Proprietor Federal Tax I.D.#
Address
City
State
Zip
Phone #
Equipment address if different than above
City
State
Zip
Fax #
Primary business function
# Years Current Owner

OWNERSHIP
Name of Principal #1
Title
Social Security #
% of Ownership
Home Address
City
State
Zip
Phone #
Name of Principal #2
Title
Social Security #
% of Ownership
Home Address
City
State
Zip
Phone #

BUSINESS BANK REFERENCE
Bank Name
Account # (Chkg.)
Loan # Phone#
Contact
Bank Name
Account # (Chkg.)
Loan # Phone#
Contact

BUSINESS TRADE/LEASE REFERENCES
Trade Name
Account #
High Credit
Phone #
Contact
Trade Name
Account #
High Credit
Phone #
Contact
Trade Name
Account #
High Credit
Phone #
Contact
Landlord :

Insurance Co.:


Agent Name:
Phone #

Phone #
Contact

Contact

EQUIPMENT/DEALER INFORMATION
Company Name Phone #
Contact
Address
City
State
Zip
Equipment to be leased (enter itemized list if available)



New
Used
Make/Model #



$ Amount



Lease Terms: 24 Months 48 Months
                     36 Months 60 Months
Purchase Option: 
$1.00 
10%   
Fair Market Value

IMPORTANT
By Submitting this application I/we hereby authorize Brentwood Credit Corporation, or its agents to investigate my/our credit worthiness and will provide financial statements, tax returns, and similar documents, as you deem necessary.