Please Email, Fax or Mail this app to:
Ph: 601-749-8424   Fax: 601-749-8425
Email:  Lease@Mega-Vending.com
Mega-Vending.com

60 Long Lake Dr.
Carriere, MS  39426

Lease Application

 

 

Date:                       File # BT

 

LESSEE  INFORMATION

Lessee Company Name

 

Phone #

 

 

Lessee Contact

 

Fax #

 

 

Lessee Address

                              

         

      

        

 

                                  Street                                               City

            County

State

           Zip

 

Corporation

Date Incorporated:

 

Fed. Tax ID#

 

 

 

Partnership

State Incorporated

 

Principal

 

 

      %

Proprietorship

Years in Business:

 

Principal

 

 

      %

Principal’s Name

 

1st  Principal  SSN

 

Home Phone

 

2nd Principal  SSN

 

Home Address

 

 

 

 

Street

City

State

Zip

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 Lease2Loan or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from the national credit bureaus.  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 should be valid as the original.  By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application.  In addition, I hereby authorize our banks, trade references, and financial institutions to release credit information to Lease2Loan and/or its assigns.

                                                                                        X ____________________________

VENDOR INFORMATION          (Company supplying the equipment)

Vendor Name

Mega-Vending.com (Breaktime Vending, inc)

Vendor Contact 

Eric Normand

Vendor Address

60 Long Lake Dr

Carriere

MS

39426

 

                    Street

City

State

Zip

Vendor Phone #

601-749-8424 ext 10

Vendor Fax #

601-749-8425

 

EQUIPMENT INFORMATION

Equipment Description

 

Cost of Equipment w/o Tax

 

 New   Used    Age  ______

Condition ______

Equipment to be Located

 

 

 

 

Street

City

State

Zip

Terms of Lease

 

Type of Lease

 

 

CREDIT INFORMATION

Bank

 

Checking Acct #

 

    Location

 

Savings Acct #

 

    Phone #

 

Loan Acct #

 

Trade/Credit Reference

 

Location

 

    Phone #

 

Contact / Acct #

 

Trade/Credit Reference

 

Location

 

    Phone #

 

Contact / Acct #

 

Trade/Credit Reference

 

Location

 

    Phone #

 

Contact / Acct #

 

Trade/Credit Reference

 

Location

 

    Phone Number

 

Contact / Acct #