Leasing Application

Lessee Company Information

Company Name:

Email Address:

Company Address:

City:

State:

Zip Code:

Signer:

Title:

Phone:

Fax:

State Corp. Filing Number:

Non-Profit Partnership Proprietor Corporation

Years In Business:

Annual Sales:

Personal Information On Officers, Partners or Guarantors

Name:

Title:

Social Security Number:

Percent of Ownership:

Name:

Title:

Social Security Number:

Percent of Ownership:

Company Bank Records - Five Year History

Bank / Branch:

How Long?

Account Number:

Phone Number:

Contact Officer:

Bank / Branch:

How Long?

Account Number:

Phone Number:

Contact Officer:

Lease / Loan References

Name:

Amount:

Account Number:

Phone Number:

Contact Person:

Name:

Amount:

Account Number:

Phone Number:

Contact Person:

Equipment Description

Please describe the equipment:

Declaration

This application submitted electronically shall have the same force and effect as if the application bore an inked original signature(s). The above information, together with any accompanying financial statements, schedules, or other materials, is submitted for the purpose of obtaining credit and is warranted to be true, correct and complete. The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his/her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and shall hold Vista Capital Corporation and its assignees, agents or nominees harmless from same. You understand that such investigation may include seeking information as to the background, credit and financial responsibility of your officers and principals (or any of them). The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please write to Vista Capital Corporation, 3030 N. Central Ave., Suite 402, Phoenix, AZ 85012.

I accept the above terms and conditons:

Enter Security Code: