E-Mail Notification
Applicant E-Mail Address

Enter your e-mail address to receive a confirmation notice.

Lease Detail
Amount *

Desired Term *

Vendor / Supplier / Dealer

Sales Rep

Business Information
Full Legal Company Name *

Doing Business As (DBA)

Address *

City *

State *

Zip *

County

Company Phone

Contact Name *

Contact Phone *

Business Structure

Date Company Formed (mm/yyyy)

Federal Tax ID

Business Property

Equipment Location Address

Time In Business At this Location

Additional Business Owned
Full Legal Name

DBA

Time In Business

Officers/Partners/Owners Information
Include all major owners's information.
If there is more than one Officer/Partner/Owner, please select the button to the right.
Title

First Name

Middle

Last Name

Generation

Ownership %

SSN

Birthdate

Street House Number (home)

Street Name (home)

City (home)

State *

Zip *

Mobile Phone

Mobile Phone

Residence

Authorization
By checking this box, Applicant(s) represents the foregoing information contained in this credit application is true and correct and that Vend Lease Company, Inc, or its designees, may totally rely on same and Applicant(s) hereby authorizes our banks, trade references and other financial institutions to release credit information to Vend Lease Company, Inc., or its designees, even if by fax or copy of this document. Applicant(s) further authorizes Vend Lease Company, Inc., or its designees, to obtain other credit information from all sources including, but not limited to, credit bureau reports on the business and any guarantors as individuals. By execution of this credit application, I/we hereby expressly waive any right(s) to notification pursuant to the Federal Equal Credit Opportunity Act, the Federal Fair Credit Reporting Act and/or any applicable state law. Applicant(s) hereby release, discharge and indemnify Vend Lease Company, Inc. from any and all claims, actions, rights, damages and costs Applicant(s) may now have, ever had, or hereafter may have in any way relating to or growing out of this credit application. By signing below, the individual(s), who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Vend Lease Company, Inc. or its designees (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a 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 and for reviewing or collecting the resulting account. A Photostat, facsimile copy or electronic signature of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individuals identified in the above application with the proper authority to act as such. It is further understood and agreed that Vend Lease Company, Inc. may, in its sole discretion, approve or reject this credit application.