NO-OBLIGATION LEASE APPLICATION

NO-OBLIGATION LEASE APPLICATION

PLEASE FILL IN THE SHORT FORM PRE-APPLICATION BELOW, WHEN FINISHED CLICK THE SUBMIT BUTTON. All information provided by you will be kept strictly confidential.

Complete Legal Name Of Business:

Date:

Physical Address:

Mailing Address, If Different:

Business Telephone Number:

Years In Business:

Tax Payer Identification Number:

Trade Name Or Style, If Any:

Type Of Business:

Equipment Location:

How Long At This Address?:

Ownership
Sole Owner Partnership Corporation Other

Principal Or Officer	Title	Social Security No.	Spouse	Home Address

Bank/Debt References

Name and Address	Contact, Telephone	Account Number	Type of Account
			Loan Checking
			Loan Checking
			Loan Checking
			Loan Checking

Trade References

Company & Address	Telephone	Contact

Vendor

Name		Address & Telephone			Equipment
Contact	New or Used?	Cost	Tax	Freight	Installation	Total Cost

Lease Structure

Number of Months	Monthly Payment	FMV P.O.
		10% PUT
		$1.00 P.O.

Insurance Information	Landlord Information
Agent	Contact
Address	Address
Telephone / Fax	Telephone / Fax

Lessee hereby authorizes and bank or other lending institution, creditor, trade, or credit association,
or trade or credit reporting bureau, or any other person who has knowledge of Lessee's credit or trade
history to release such information to (Smith Capital And Finance) or its assigns or designee(s). A
photographic or faxed copy of this authorization shall be as valid as the original. The undersigned
agrees to reimburse any actual expenses within ten (10) days of invoice by Lessor as needed to
complete the lease transaction.

Name:
Title:
Date:

Smith Capital And Finance
37875 W 12 Mile Rd Suite 203
Farmington Hills , MI 48331

Phone:    (248) 553-7000
Fax:          (248) 553-7060
Email:     financing@smithcapitalandfinance.com
WebSite: www.smithcapitalandfinance.com