Equipment Lease Application

Phone (310) 828-1199  Fax (310) 828-7781
BUSINESS/Company Information
Legal Business Name/d.b.a
 Corporation Partner Sole Proprietor Federal Tax I.D.#
Address
 City
 State
 Zip
 Phone #
Equipment address if different than above
 City
 State
 Zip
 Fax #
Primary business function
 # Years Current Owner
OWNERSHIP
Name of Principal #1
 Title
 Social Security #
 % of Ownership
Home Address
 City
 State
 Zip
 Phone #
Name of Principal #2
 Title
 Social Security #
 % of Ownership
Home Address
 City
 State
 Zip
 Phone #
BUSINESS BANK REFERENCE
Bank Name
 Account # (Chkg.)
 Loan # Phone#
Contact
Bank Name
 Account # (Chkg.)
 Loan # Phone#
Contact
BUSINESS TRADE/LEASE REFERENCES
Trade Name
 Account #
 High Credit
 Phone #
 Contact
Trade Name
 Account #
 High Credit
 Phone #
 Contact
Trade Name
 Account #
 High Credit
 Phone #
 Contact
Landlord :

Insurance Co.:

Agent Name:
 Phone #

Phone #
 Contact

Contact
EQUIPMENT/DEALER INFORMATION
Company Name Phone #
 Contact
Address
 City
 State
 Zip
Equipment to be leased (enter itemized list if available)



 New
 Used
 Make/Model #



 $ Amount
Lease Terms: 24 Months 48 Months
                     36 Months 60 Months
 Purchase Option: 
$1.00 
10%    		Fair Market Value

IMPORTANT
By Submitting this application I/we hereby authorize Brentwood Credit Corporation, or its agents to investigate my/our credit worthiness and will provide financial statements, tax returns, and similar documents, as you deem necessary.