Application

Lessee Information
Company	required
dba		Contact
Address	required
City	required	County	required
State	required	Zip	requiredinvalid
Telephone	requiredinvalid	Fax
Email	requiredInvalid	Website
Nature of Business		Date Established
Fed ID		Location	Own Rent	Sq. Ft.
Landlord		Telephone
Business Structure	C Corp S Corp LLC Partnership Proprietorship Non Profit
State of Corporation		Corporate ID#

Description of Equipment
Description
Vendor		Contact
Telephone		Price of Equipment	New Used

Personal Information on Officers, Partners, or Guarantors
Name		Title
Soc. Sec. #		Birth Date
Home Address		City
State		Zip
Telephone

Name		Title
Soc. Sec. #		Birth Date
Home Address		City
State		Zip
Telephone

Bank References
Bank Name		Contact
Telephone		Fax
Checking Account#		Loan Account#

Bank Name		Contact
Telephone		Fax
Checking Account#		Loan Account#
Current Lease Obligation yes no
Name of Co./Bank		Account #

Insurance
Agent's Name		Contact
Address		City
State		Zip
Telephone

Trade References
Supplier Name
Telephone		Fax

Supplier Name
Telephone		Fax

Supplier Name
Telephone		Fax

required	Clicking the checkbox preceding this statement certifies that the above information given for credit purposes is true and correct and authorizes Artromick Capital or person to whom this application is made and any credit bureau or other investigative agency to investigate the references, statements, or other data listed or accompanying this application. Clicking the checkbox preceding this statement authorizes all parties to release credit and financial information requested as part of said investigation.

Artromick Leasing