LEASE APPLICATION

LESSEE (complete legal name of entity. If a corporation, use EXACT registered corporate name.)

CompanyDBA

Business Address City

State Zip

Telephone# Contact Person

Number of Years in Business (present ownership)

Nature of Business Number of Employees

Type of Business Corp (reg. in state of _____ ) Municipality Non-Profit Proprietorship Partnership


PERSONAL INFORMATION ON OFFICERS, PARTNERS, OR GUARANTOR

Name Title Social Security#

Home Address City State Zip

Home Telephone #

Name Title Social Security#

Home Address City State Zip

Home Telephone #


COMPANY BANK REFERENCES

Name of Bank/Branch City/State

Checking Acct# Loan Acct#

Telephone# Contact Officer

Name of Bank/Branch City/State

Checking Acct# Loan Acct#

Telephone# Contact Officer


TRADE REFERENCES

Name of Suppliers City/State

Telephone# Acct#

Name of Suppliers City/State

Telephone# Acct#

Name of Suppliers City/State

Telephone# Acct#

Name of Suppliers City/State

Telephone# Acct#


VENDOR INFORMATION

Northeast Restaurant Equipment
94 Industrial Drive
Mashpee, MA 02649
508-477-3433
508-477-5515
Joseph LaVoie


Equipment Description

Price Term Factor Sales Tax

Monthly Payment $1.00 Purchase Option

Advance Payments 10% Purchase Option


RELEASE
I verify the accuracy of the above information and authorize Marlin Leasing to contact my bank(s) to verify the acceptability of my credit.

Signature Title Date

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