Secure Business Lease Application

Lessee
Tax I.D number
Company*
Address*
City*  State*    Zip* 
Phone*  Fax 
E-Mail*
Nature Of Business*
 
Type Of Business (Check One)* Years In Business* Tax Exempts*
Corporation   Partnership   Sole Proprietor Yes   No
Principal 1*  Title   % Ownership* 
Home Address*
City*  State*    Zip* 
Social Security Number *
Principal 2  Title   % Ownership 
Home Address
City  State    Zip
Social Security Number

Bank Information & Trade References
Name Of Bank*  Contact 
Phone*  Checking Account Number* 
Trade Reference 1  Contact 
Phone
Trade Reference 2  Contact 
Phone

Vendor/Supplier of Equipment
Vendor  Contact 
Phone

Equipment
Description
Price
 
Total Build Out Cost*
 
Is the Equipment* Estimated Delivery Date (Check One)*
New   Used 30 Days    60 Days    90 Days    Over 90 Days

Structure Requested
Term (Check One)* Buy Out (Check One)*
36 Months $1 Buy Out
48 Months 10% Buy Out
60 Months True Lease

Information Release
By clicking the submit button, I hereby authorize United Capital Funding Services, its designees or assigns to make
business and or personal credit inquiries as necessary throughout the lease. I understand that this may include a
personal credit bureau which will be used in the credit evaluation process. I also authorize United Capital Funding
Services, its designees or assigns to contact me via any means or media deemed necessary.

* = input is required
 
   
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