American Leasing, Inc.
Lease Application
(do not press ENTER until finished use TAB or SHIFT+TAB to move between fields) Fields in red are required
Legal Company Name
Address
Address
City
County
State     Zipcode
Phone     FAX

Vendor's Name
Address
Address
City
State     Zipcode
Phone     FAX
Contact

Time in business under present ownership
State of incorporation

Business Type (choose one)
Corporation     Partnership     Proprietorship

Federal ID Number
State ID Number
Nature of Business

Ownership
Full Name
Home Address
Home Address
City
State     Zipcode
Social Security #     %Ownership

Full Name
Home Address
Home Address
City
State     Zipcode
Social Security #     %Ownership

Full Name
Home Address
Home Address
City
State     Zipcode
Social Security #     %Ownership

Name
Home Address
Home Address
City
State     Zipcode
Social Security #     %Ownership

Bank References
Bank
Account #
Contact
Phone #
Checking     Savings     Loan

Bank
Account #
Contact
Phone #
Checking     Savings     Loan

Bank
Account #
Contact
Phone #
Checking     Savings     Loan

Bank
Account #
Contact
Phone #
Checking     Savings     Loan


Trade References
Credit Reference Name
Account #     Phone #
City
State     Zipcode

Credit Reference Name
Account #     Phone #
City
State     Zipcode

Credit Reference Name
Account #     Phone #
City
State     Zipcode

Credit Reference Name
Account #     Phone #
City
State     Zipcode

Equipment to be Leased:
Quantity     New     Used
Manufacturer
Model
Description
Serial #
Price w/o Tax

Quantity     New     Used
Manufacturer
Model
Description
Serial #
Price w/o Tax

Quantity     New     Used
Manufacturer
Model
Description
Serial #
Price w/o Tax

Quantity     New     Used
Manufacturer
Model
Description
Serial #
Price w/o Tax


Please check here to verify authorization for all listed bank and trade references, both business and personal, to release any information requested by American Leasing, Inc. regarding your accounts.

By submitting this application, the applicant certifies that all information included is true and correct.

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