Exchange Leasing Fax Application

Please fax to 425-235-9087 or call Ruth Reutimann at 888-532-7302 for more information.

Legal Company Name: _______________________________________________________
Address: ___________________________________________________________________
City: _________________________________________State: _________ ZIP: __________
Phone: _____________________ Fax: ______________________

Guarantors / Signors
Name: ________________________________ Title: ________ Soc. Sec#: ______________
Address: ____________________________________________________________________
Name: ________________________________ Title: ________ Soc. Sec#: ______________
Address: ____________________________________________________________________

Bank References:
Bank Name: ______________________________ Contact: __________________________
Telephone#: ______________________________ Acct#: ____________________________
Bank Name: ______________________________ Contact: __________________________
Telephone#: ______________________________ Acct#: ____________________________

Landlord: ________________________________________ Telephone: ________________
Monthly Rent: ____________________________ How long? ________________________

Credit References - Suppliers, Leases, other Loans
Name: ___________________________________________ Telephone: ________________
Name: ___________________________________________ Telephone: ________________
Name: ___________________________________________ Telephone: ________________

Description of equipment to be leased

Cost of equipment? $_______________________
Supplier: _____________________________________________ Telephone: ____________

I understand that Exchange Leasing* is relying on this information in extending any credit and is warranted to be true. I hereby authorize Exchange Leasing* or any credit bureau or other investigative agency employed by Exchange Leasing* to investigate the references herein listed or statements or other data obtained from me or any other person pertaining to my credit an financial responsibility. The undersigned authorizes all parties contacted to release credit and financial information requested as a part of said investigation * or its successors or assigns

Signature of proposed lessee: _____________________________ Title:_______ Date:_______