Equipment Leasing Application

Business Information:

	Exact Legal Company Name:
*	Phone:
	Cell:
	Fax:
	Mailing Address:
*	Email Address:
	Declare Bankruptcy?:
	Type of Business:
	Age of Business:
	FEIN:
	Equipment Location:
	Country:
	Business Type:
Ownership Information:

*	Principal's Name:
	Title:
	% Ownership:
	SSN:
	Home Address:
	Phone:
	Principal's Name:
	Title:
	% Ownership:
	SSN:
	Home Address:
	Phone:
Equipment Information:

	Supplier:
	Contact:
	Phone:
	Cell:
	Email:
	Address:
	Type of Equipment:
	Equipment Cost:
	Equipment Condition:
	If Refurbished - Age of Equipment:
Trade Reference Information:

	Company Name:
	Contact:
	Phone:
	Company Name:
	Contact:
	Phone:
	Company Name:
	Contact:
	Phone:
Bank Reference Information:

	Bank:
	Branch / Location:
	Account Under Name of:
	Account #:
	Phone:
	Fax:
	Bank:
	Branch / Location:
	Account Under Name of:
	Account #:
	Phone:
	Fax:
Authorization To Obtain Credit Information:
Applicant warrants all credit and financial information submitted to A-Target, Inc., dba Treger Financial (hereafter referred to as TREGER) and/or its assignees to be true and accurate and hereby authorizes all banking institutions and credit reporting agencies to release necessary information via telephone, mail, Internet or facsimile as requested for purposes of making a credit decision. The undersigned individuals specifically authorize TREGER and/or it assigns to obtain personal credit bureau reports for the making, extension, or renewal of this credit decision or collection of the resulting account. A fax or photocopy of this authorization shall be valid as the original.
	I Authorize:

* denotes required field.