LEASE APPLICATION

Please complete the information in the following application to begin the process. If you wish to retain a hardcopy for your records, you may do so by clicking the print page button prior to submitting this form for approval (* indicates required information).
 
Initial Funding Information
 
*Enter Equipment Description
 
*Enter Base Payment or Equipment Cost
Desired Base Payment: For Months(Term)
             - or -
Total Equipment Cost:
 
Guarantor 1 Information
 
*Guarantor Name:
*SSN:
*Street Address 1:
 Street Address 2:
*City:
*State:
*ZIP Code:
*Primary Phone:
 Alternate Phone:
*Email:
*Confirm Email:
 Own Residence:
 Years At Residence:
 
Guarantor 2 Information (if applicable)
 
 Guarantor Name:
 SS#:
 Street Address 1:
 Street Address 2:
 City:
 State:
 ZIP Code:
 Primary Phone:
 Alternate Phone:
 Email:
 Confirm Email:
 Own Residence:
 Years At Residence:
 
Please Authorize:
The undersigned applies for the lease indicated in this application. Everything stated in this application is correct. TimePayment Corp. may retain the application whether or not the lease is approved. TimePayment Corp. is authorized to check my credit and employment history for the purposes of determining my credit worthiness at the time of my application or thereafter in connection with the same transaction or extension of credit and for the further purpose of reviewing the account, taking collection activity on the account, and skip tracing. TimePayment Corp. is authorized to provide history information to others about my credit standing and your credit experience with me, including but not limited to credit bureaus, other companies, outside collection agencies and outside attorneys.
*I agree to the terms above.
 
*Authorized Signature:
*Date:
*I agree to adopt this typed representation of my name as my signature.