Equipment Leasing Application

for

www.affordablefoodserviceequipment.com

CREDIT APPLICATION

Date: ____________

General Information:

Lessee (Customer)___________________________________________________________________________

Street: ____________________________________________________________________________________

City: ____________________________State: _________ZIP: _____________County: ___________________

Telephone: _______________________FAX: ________________________Years in Business: _____________

Nature of Business: ___________________________Authorized Representative: ________________________

Equipment:

Quantity Description Cost

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Bank References:

Name of Bank # 1______________________________Name of Bank # 2______________________________

Telephone: ____________________________________Telephone: ___________________________________

Contact Officer: ________________________________Contact Officer: ______________________________

Account #_____________________________________Account #___________________________________

Trade References:

Company Address Telephone Contact

1_________________________________________________________________________________________

2_________________________________________________________________________________________

3_________________________________________________________________________________________

Principals/Owners Information:

Name: ______________________________________Name: ________________________________________

Home Address: ______________________________ Home Address: _________________________________

_______________________________ __________________________________

Telephone: __________________________________ Telephone: ___________________________________

Social Security No.: ___________________________Social Security No.______________________________

Vendor Information:

Name: Telephone:_______________

Address: City: State / ZIP: _______________

Salesperson: _ ______________________

I, the undersigned authorizes the release of financial / credit information on the above company/person.

Authorized By: ______________________________Title: ____________________Date: _________________

Print Name: _________________________________