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 form button prior to submitting this form for approval. (*indicates required information)
Initial Funding Information
*Equipment Description
Fill in ONE of the following fields
Desired Base Payment: $ For Months(Term)
Or Total Equipment Cost: $
* Guarantor Information
*Guarantor Name:
*Date Of Birth:
*ZIP Code:
*Home Phone:
Work Phone:
Cell Phone:
Your Title:
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   I Do Not Agree
*Authorized Signature:
*Print Name:
*Adopt this typed representation of my name and title as my signature.
I Agree   I Do Not Agree