Printable Application
LESSEE
(COMPLETE LEGAL NAME OF ENTITY. IF CORPORATION, USE EXACT REGISTERED NAME)
Company Name:
Type Of Business (Select one):
Non Profit
Company Address:
Proprietorship
Partnership
City, State, Zip:
Corporation
LLC
Phone:
Signer:
Fax:
Title:
PERSONAL INFORMATION (OFFICERS, PARTNERS OR GUARANTORS)
Name:
Social Security Number:
% Owned:
Title:
Phone Number
Address:
City, State, Zip:
Credit Rating :
BELOW 600
601-650
651-700
ABOVE 700
Name:
Social Security Number:
% Owned:
Title:
Phone Number
Address:
City, State, Zip:
Credit Rating :
BELOW 600
601-650
651-700
ABOVE 700
EQUIPMENT INFORMATION
Type Of Equipment:
Purchase Date:
Cost Of Equipment:
Desired Term:
Equipment Is:
Preferred Payment Options:
NEW
USED
NORMAL
SEASONAL
DEFERRED
Vendor Name:
Vendor Dealer:
DECLARATION
Authorization: By submitting this application, applicant warrants that all the information provided is true and correct and authorizes Cornerstone Capital Group and its assignees to investigate applicants credit worthiness as may be needed. The undersigned authorizes all banking institutions, credit reporting agencies and its agents to release all necessary information via telephone, mail or facsimile as requested, for the purpose of securing a lease, updating, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account.
Applicant Name:
Applicant Title:
Applicant E-mail:
Account Manager's Name (if any):
