Fleet Finance Application

Personal Information

Officer Name*

First Last

Title*

Ownership %*

Home*

Own
Rent

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Personal Information

Second Officer

Officer Name*

First Last

Title*

Ownership %*

Home*

Own
Rent

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Information

Bank Name*

Account Number*

Contact

Phone

Add additional bank

Bank Name*

Account Number*

Contact

Phone

Equipment/Vehicle Information

Make*

Model*

VIN*

Amount $*

Time Frame of Acquisition*

Lease Term in Months*

Purchase Option*

$1
10%

Monthly Budget $

By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application.

Signature*

Simply type /s/ before your name; e.g., /s/ John Smith. This identifies it as being a signature, letting us know that you consent to the terms and conditions of this application.

Date*

Signature (Second Officer)*

Simply type /s/ before your name; e.g., /s/ John Smith. This identifies it as being a signature, letting us know that you consent to the terms and conditions of this application.

Date*

Fleet Finance Application

Company Information

Personal Information

Personal Information

Bank Information

Equipment/Vehicle Information

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Fleet Services

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