All fields are required

Legal Corporate Name

DBA

Physical Address


City


State


Zip Code


Website

Phone Number


Federal Tax ID


Type of Entity: (Select One)

Owner Name

Title

Length of Ownership

Home Address

City

State

Zip Code

Ownership %

Date of Birth

Home Phone Number

Cell Phone Number

Number of Locations/Stores

Average Monthly Gross Revenue

Average Ticket Price of Equipment

Type of Equipment Sold

Other Financing Companies Used (References)

Email: info@clicklease.com
Phone: 888-509-5592

By signing above, the Applicant hereby authorize the required parties to obtain a consumer report from a credit bureau or credit agency and to investigate any other data on the Applicant they deem necessary to evaluate the approval of this application.