1. Personal Information
Name: Zip Code: Address: Phone: City: Fax: State: Email:
2. Equipment Information
Equipment Cost: Term: Equipment Description: Buyout: Equipment Location:
4. Business Information
Time in Business: Industry: Business Structure: Proprietorship Partnership Corporation
5. Guarantors/Owners
Name: Address: SSN: Position:
6. Bank Info
Bank Name: Bank Phone #: Account #: Contact Name: Checking Loans
7. Installment Debt
Type: Name: Phone #: Account #: Contact:
8. Major Trade Accounts
Name: Phone #: Contact:
9. Landlord/Mortgage Holder
Name: Phone #: Contact:
By clicking the box on the left I hereby certify that the information contained in this application is true and accurate to the best of my knowledge. For the purpose of securing lease financing, I authorize all bank and trade reference information to be released by telephone or fax to Tommel Financial Services, Inc. or Banker's Leasing Corporation.