ATMCentral ATM Sales and Service

Tel: 727-345-8460                                         LEASE APPLICATION                                   Fax: 727-344-0285

COMPANY INFORMATION - LESSEE

 Business Name:   Contact: 
 Address:
 City:     State:     Zip:  Country:
 Phone:    Years in Business:    Type of Business:
 Please Check One:  Corporation Partnership Sole Proprietor Tax ID #:
Sales Rep: Phone #:
Equipment Price: Purchase Option: $1.00 Buy-out 10% Buy-out
Equipment Description:

CREDIT INFORMATION
Information on owners: 

1) Name: Phone:   Social Security #: 

Address:

2) Name: Phone:   Social Security #: 

Address:

3) Name: Phone:   Social Security #: 

Address:
BANK REFERENCES:                         If less than 2 year relationship please provide previous bank.
1) Name: Checking Account #:
Contact Person:   Phone:
2) Name: Checking Account #:
Contact Person:   Phone:
TRADE REFERENCES:
1) Supplier Name: Contact:
Address: Phone:  
2) Supplier Name: Contact:
Address: Phone:  
3) Supplier Name: Contact:
Address: Phone:  



For the purpose of securing lease financing I authorize all deposit and borrowing information to be released by telephone or fax.


                  BY:                                                                                                            



Please complete then print and sign the form, then fax it to: 727-344-0285

Please contact our Sales Department with questions or comments.
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