Equipment Leasing Application

Business Information

Exact Legal Company Name

Phone(Required)

Cell

Fax

Mailing Address

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Declare Bankruptcy?

Type of Business

Age of Business

FEIN

Equipment Location

Country

Business Type

Ownership Information

Principal's Name(Required)

Title

% Ownership

SSN

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

Principal's Name

Title

% Ownership

SSN

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

Equipment Information

Supplier

Contact

Phone

Cell

Address

Street Address Address Line 2 City State ZIP Code

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

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