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Lease Application

Vendor Information

                     

Vendor Name:__________________________________________________________
Address:_____________________________City:________State:_______Zip:_______
Fax#:(        )__________________________Telephone # (       )___________________

Lessee Information

Full Legal Name:_________________________________DBA____________________
Address:_____________________________City:________State:________Zip:_________
Years in Bus:._______#of employees:_____Contact person:___________ Title:_________
Nature of Business:________________________________________________________
Business Type: Corp____Prop._____Partner_____ LLC________

Personal Information

Officer:________________________Social Security: ____-____-_____
Title:_____________
Address:____________________________City_________
State __________Zip_________
Officer:________________________Social Security____-____-______Title____________
Address:____________________________Dity_________State__________Zip_________

Trade References

Name:__________________________________
Tel#(     )______________Contact____________________
Name:__________________________________
Tel#(     )____________Contact____________
Name:__________________________________
Tel#(     )_____________Contact____________

Landlord Information
Name:__________________________________Tel#(    )____________-Contact____________

Bank Information   
(two year history)
Bank Name:_____________________ checking______savings ________loan__________
Tel.#(      )________________Contact name:__________________Acct#______________
Bank Name;_____________________checking_______savings________loan__________
Tel#(      )________________Contact name___________________Acct#______________
Release authorization: Lessee hereby authorizes Lease One Corp.,and it's affiliates to obtain credit information from Banks, Trade References, Credit Reporting Services and Financial Institutions regarding credit worthiness. Every thing stated in this application is true and correct.
Authorization to Release to Banks: This my/our authorization for herein listed bank references to release any information requested as part of Lease One Corp.s normal credit procedures
._________________________________________________________________________
Signature     
Broker 110-125                                            Title                          Date

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To contact us:

Phone: 603-929-7007
Fax: 603-929-7007
Email: clucus@breezy.com