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Consolidated Capital Company
p: (262)-225-1122
e: info@conscap.net
Application Form
Vendor
*
Email
*
Type of Equipment
*
Sales Contact
Cost of Equipment
*
Phone
*
Lease Term
*
Please Attach Equipment Quote(s) if available
Drop files here or
LESSEE CREDIT INFORMATION
Business and/or Personal Financial Statements may be necessary depending upon years established, credit and total investment.
Lessee Company Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Type of Business
*
Fax
Equipment Location
*
Mobile Phone
Email
*
Contact
*
Federal ID Number
*
COMPANY/OWNERSHIP INFORMATION
Business Started
*
Date Format: MM slash DD slash YYYY
President
*
Secretary
Present Owners Since
*
Date Format: MM slash DD slash YYYY
Vice President
*
Treasurer
Name
First
Last
Principle
*
Social Security Number
*
Home Phone
*
Home Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Principle
Social Security Number
Home Phone
Home Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Net Worth
*
Business Organization
*
Proprietorship
Partnership
Corporation
BANK INFORMATION
Current Bank
*
Account # or Loan #
*
Bank Officer
*
Phone
*
TRADE REFERENCES
Company Name
*
Contact
*
Phone
*
Company Name
*
Contact
*
Phone
*
Signature
*
Lessee/borrower represents and warrants that all credit and financial information submitted to lessor/lender herewith, or at any other time is true and correct. I hereby authorize our banks, trade references, and financial institutions the right to release credit information and lessor/lender to run any consumer credit bureau reports or other such reports.
Date
*
Date Format: MM slash DD slash YYYY
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