10645 N. Oracle Rd, Suite 121, PMB 231 Oro Valley, AZ  85737-9388 Phone: 520-628-9929 or 800-532-7303 (800-LEASE-03) Fax: 520-628-9949 Contact Us By EMail http://www.Lease-Smart.com/
LEASE APPLICATION

Exact Name of Company: Fed ID# if Corp: Structure of Company Corporation Indicate State L.L.C. Indicate State Proprietors Partnership Business Open How Long? Contact Person: How Long by this Owner? Business Phone: (        ) How Long at this Address? Fax No.: (        ) Business Address: (Street, City, County, State & Zip) Business Description: Your e-mail:

Owners/Officers/Partners (Indicate if Jr, Sr, II or III) Title Own% Home Address (street, city, state & zip) Home Phone Soc. Sec. No.         (        )           (        )           (        )

Business Bank - Branch Bank Officer Phone Account No. Chkg Svings Loan     (        )             (        )

Other Active Leases Contact Phone Account No. Equipment Leased     (        )         (        )         (        )

Trade/Supplier Credit References (city, state) Phone Contact Name Account No.   (        )       (        )       (        )       (        )

Insurance Carrier Agent Phone Mail Address

Location of Equipment: (street, city, state, zip) Equipment Description:

Vendor: Contact: Phone:  (       ) Vendor Address: (street, city, state and zip)

Briefly DESCRIBE and QUANTIFY HOW MUCH the leased item(s) will benefit your company Urgency: HOW SOON do you plan to complete this acquisition? O  Immediately O  Within 30-90 days O  Within 30 days O  Undetermined/Just shopping Remarks:

Price of Equipment: $ Lease Term: Purchase Option:

By signing below, the undersigned individual(s), who is either a principal of the above-named business credit applicant or a personal guarantor of its obligations, provides written authorization(s) to Lease$mart and its assigns (and any assignee or potential assignee thereof) for review of his/her personal credit profile from any 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 photocopy or facsimile 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. Additionally, my/our business, banking and trade references are hereby authorized and instructed to disclose all information requested in connection with this application for credit.   By:______________________________________       Signature required Date:___________________ By:______________________________________       Signature required Date:___________________