Imaging3 Leasing Information and Application Form
Lease and Rental Programs
We offer many creative financing packages. We have rent, rent-to-own, lease,
and purchase options available. Additionally, custom leases can be created
to fill almost any need and meet any budget. If you have an unusual request,
just ask; chances are we have satisfied the same request before.
Please print the following Equipment Lease Application and fax to 1(818)
260-0445
Business
Information
Name of Business:______________________________ Business Fed
ID #:__________________________
Business Address:______________________________ City / State / Zip:____________________________
Business Telephone #:_________________ Business Fax #:________________
Email:________________
What kind of ownership does the business have? [please select]
Corporation / Since:____________ Sole proprietorship Partnership
Time in Business:______________
Type of Equipment:____________________________________________________________
New or Used?
Amount Requested:____________________ Term Requested: 36,
48, 60, 72 Months D&B #:________
Address where equipment will be used:________________________________________________________
Vendor:_______________________________ Contact:_________________________
Phone:___________
Ownership
Principal’s Name # 1:__________________________ Title:__________________
Ownership:__________%
Home Address:___________________________________________ City / State
/ Zip:_________________
Home Telephone #:__________________________________ Fax #:_______________________________
Social Security #:_____________ Licensed Doctor? Yes / No
License #:_______ Yrs Licensed:______
Principal’s Name # 2:__________________________ Title:__________________
Ownership:__________%
Home Address:___________________________________________ City / State
/ Zip:_________________
Home Telephone #:__________________________________ Fax #:_______________________________
Social Security #:_____________ Licensed Doctor? Yes / No
License #:_______ Yrs Licensed:______
Bank & Trade Information:
Bank Name:___________________________________ Bank Account #:___________________________
Contact Name:________________________ Bank Telephone #:______________
Fax #:_____________
Trade Reference # 1:______________________________ Trade Account #:__________________________
Contact Name:________________________ Bank Telephone #:______________
Fax #:______________
Trade Reference # 2:______________________________ Trade Account #:__________________________
Contact Name:________________________ Bank Telephone #:______________
Fax #:______________
Trade Reference # 3:______________________________ Trade Account #:__________________________
Contact Name:________________________ Bank Telephone #:______________
Fax #:______________
Credit Release: I hereby authorize our banks, trades, and financial
institutions to release credit information to Lessor / ISI I further authorize
Lessor / ISI to obtain credit information including D&B reports and
Credit Bureau reports.
____________________________________________________________
________________________
Signature
Date
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