Commercial Lease Application

Dealer Code: 064QA

indicates required fields

Business Information

Legal Business Name

DBA Name

Your Full Name

Your Title

Email Address

Confirm Email Address

Business Address

Business Address Cont'd

City

State

Zip Code

Primary Phone

Secondary Phone

Time in Business

Years Months

Federal Tax ID:

Type of Business

Owner/Guarantor Information

Full Name

Title

Social Security #

Home Address

Home Address Cont'd

City

State

Zip Code

Primary Phone

Secondary Phone

Email Address

Confirm Email Address

Add a 2nd Owner/Guarantor to this Application?

Yes No

Equipment Information

Equipment Description

Total Equipment Cost

Authorization and Representation

Authorization

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

Authorized Signature

Signature Agreement

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

Date Signed