BILTMORE
LEASING CORP.
2415 E. Camelback Rd., Suite 700, Phoenix AZ 85016
(602) 840-0404 FAX (602) 840-4044 (602) 840-0406
LESSEE INFORMATION
Business Name:________________________________________Federal
ID _________________ Contact:_____________________________________Email: _____________________________
Phone: ( )___________-_____________
Fax: ( )__________-____________
Address:______________________________________________________________________
_____Corporation/LLC Name and Title of Officer Signing_____________________________
_____Partnership Description
of Business______________________________________
_____Proprietorship Year started in business______________________________________
Principal's Name:____________________________________ SSN#______________________
Home Address:__________________________________________________________________
Percent of ownership___________% Mobile Phone ( )_________-____________
EQUIPMENT INFORMATION
Vendor Name:___________________________________________________________________
Address:________________________________________________________________________
Contact:______________________________________ Phone: (
)________-____________
Equipment Description:___________________________________________________________
Cost of Equipment w/o tax $ __________________________________________
Equipment Location: ________________________________________________
Terms Wanted: ________Months $1.00__ FMV__
CREDIT INFORMATION
Bank: ___________________________________
Chk Acct. #____________________________
City _____________ Phone ( )__________-____________
Contact __________________
Trade Reference No. 1 ____________________________________ City ___________________
Phone ( )_____________________________
Contact______________________________
Trade Reference No. 2 ____________________________________ City ___________________
Phone ( )_____________________________
Contact______________________________
Credit Release Authorization
By signing below,
the undersigned individual as principal of and/or guarantor for the
applicant, authorizes BILTMORE LEASING CORP., its designee, assigns
or potential assigns, to review his/her personal credit profile provided
by national credit bureaus in considering this Application and for the
purpose of the update, renewal, or extension of credit to the Applicant
or the collection of any resultant accounts. A fax or photocopy of this
authorization shall be valid as original.
X______________________________________