Custom Decor
1500 Brittmoore #103, Houston, Texas 77043
713-983-0789, 800-720-1680
713-937-4610 Fax
LEASE APPLICATION
Date: __________________________
Equipment description: _______________________________ [ ] New [ ] Used (Year:_______)
Equipment to be located:_____________________________________________________________
Amount Requested: $________________ Lease Term Requested: ________ months
Company Information
Business Information
Name:____________________________________________________________________
DBA: ___________________________________________ D&B Rating:_________________
Address: ______________________________ City _______________ State ___ Zip ________
Phone: ______________________ Fax: ___________________________
Contact Person: ____________________________________ Title: _______________________
Years in Business: _______ Type of Business: [ ] Corporation [ ] Partnership [ ] Proprietorship
SIC Code(s): ____________________ Fed. ID # _____________________________
Nature of Business: ______________________________________________________
Principal Owners
1. Name:__________________________________________ Phone: ____________________
Soc. Sec. #: ______________________ DL#: _____________________ State: ______
Full Address: _________________________________________________________________
2. Name:__________________________________________ Phone: ____________________
Soc. Sec. #: ______________________ DL#: _____________________ State: ______
Full Address: _________________________________________________________________
Credit Information
Bank References: (if less than 2 years, also provide prior bank)
Bank Name: ____________________________ Bank Name:___________________________
Phone: ________________________________ Phone:_______________________________
Contact:________________________________ Contact:_____________________________
Name on Acct: ___________________________ Name on Acct:________________________
Type of Acct: ____________________________ Type of Acct._________________________
Acct. #:_________________________________ Acct. #:_____________________________
Accountant:
Accounting Firm: _________________________________________________________
Contact:________________________________ Phone: _________________________
Trade References:
1. _______________________________________________ Phone:____________________
2. _______________________________________________ Phone:____________________
3. _______________________________________________ Phone:____________________
Banks and Lenders will not release credit information without customer approval. I represent the above to be true and correct and hereby authorize the release of credit and financial information.
Authorized Signature: _________________________________________ Title: ____________________
Use additional sheets, if necessary to provide all pertinent information.