Lease Application

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Pinnacle Leasing LEASE APPLICATION

7585 West 66th Avenue Suite 300


Arvada, CO 80003 Brian O'Donnell, ext.226
Tel (303) 302-1413 Toll-Free (866) 612-9293
Fax (720) 263-4144 Fax (720) 263-4144
[email protected]
COMPANY INFORMATION
Full Legal Company Name

Address VENDOR INFORMATION

City County State Zip


Amount New or Used
Contact Person Telephone Fax
Equipment Description
Nature of Business Federal Tax ID Number Years in Business

Corporation Proprietorship Non-Profit Partnership LLC


Location of Equipment (if different than above) Years at this Location Email Address

PERSONAL INFORMATION FOR ALL OWNERS, OFFICERS AND GUARANTORS


Name Title Social Security Number % Ownership

Home Address Home Telephone Number

Name Title Social Security Number % Ownership

Home Address Home Telephone Number

Name Title Social Security Number % Ownership

Home Address Home Telephone Number

Name Title Social Security Number % Ownership

Home Address Home Telephone Number

BANK REFERENCES
Name of Bank Account Number Telephone Contact

SUPPLIER
Main Supplier Account Number Telephone Contact

LANDLORD AND INSURANCE


Landlord for Equipment Location Telephone Contact

Business Insurance Company Telephone Contact

Credit Authorization: I/We hereby authorize Pinnacle Leasing, its designee, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and for the
purpose of updating, renewing, extending additional credit or the collection of any late account. I/We hereby authorize our references to release all credit information and I/We represent and warrent that the information submitted
herein is true, complete and accurate. A facsimile, electronic or other copy of this authorization shall be as valid as the original.

Signature(s) of all owners, officers and/or guarantors Date

X X
X X

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