Commercial Lease Application

Business Information

Business Name

DBA Name

Your Full Name

Your Title

Email Address

Confirm Email Address

Street Address

Street Address Cont'd

City

State & Zip

Business Phone

Time in Business

YearsMonths

Federal Tax ID

Type of Business

Equipment Information

Equipment Description

Total Equipment Cost

Click here for Business Alone Credit (min 3 years in business)

Owner / Guarantor Information

Full Name

Title

Social Security #

Home Address

Home Address Cont'd

City

State & Zip

Primary Phone

Email Address

Confirm Email Address

Add Personal Guarantor to Application?

Yes No

2nd Owner / Guarantor Information

Full Name

Title

Social Security #

Home Address

Home Address Cont'd

City

State & Zip

Primary Phone

Email Address

Confirm Email Address

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. and its Authorized Affiliates are 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.

I Agree to the terms above

Authorized Signature

Date

I Agree to adopt this typed representation of my name as my signature