Autodialersonline.com Online Lease Application
Equipment Supplier:
Term:
Equipment Description:
Equipment Cost:
Applicant Name:
Date of Birth:
Social Security Number:
Home Address:
City:
State:
Zip Code:
Duration of Residence - Years/Months
Home Phone:
Business Phone:
Business Fax:
Email:
Business Legal Name:
Business Address:
Business City:
Business State:
Business Zip Code:
Year Started:
% of Ownership:
Nature of Business:
Please check applicable box and complete this form to identify the correct legal status of your business.
Individual for a Business Purpose
Proprietorship
Full Legal Name:
DBA:
Partnership
General
Limited
Number of Partners:
General Partner(s):
Please send copy of Partnership Agreement to us within three (3) days of signing the lease agreement.
Limited Liability Corporation
Number of Members:
Authorized Signing Member:
Please send copy of LLC Agreement to us within three (3) days of signing the lease agreement.
Corporation
State of Incorporation:
President:
Secretary:
Vice President:
Treasurer:
Please send copy of Articles of Incorporation to us within three (3) days of signing the lease agreement
I authorize Lease Acceptance Corporation, a division of Federated Financial Reserve Corporation, to investigate my financial responsibility and creditworthiness, and obtain one or more retail credit reports. I declare that I am an individual with a business purpose or that I am an authorized signer for the above legal entity.
Signature:
Dated:
Signature (Please attach copy of photo identification, e.g., driver's license)
1-800-364-4086
