Missouri Application

Equipment Details
Dealer Business Name*
Dealer Email*
Dealer Email 2
Dealer Email 3
Cash Price / Retail*
excluding sales tax
Condition*

NewUsed
Year*
Make*
Model*
Serial #*
Description
GPS Serial #

Lease Details
Lease Months to Ownership*
Monthly Rental Payment
Use Tax %
Use Tax
Total Monthly Payment
including sales tax
Security Deposit
TOTAL DUE
Total of Payments
You must pay this amount to own the property if you make all regular payments. You can buy the property for less under the early purchase option.
Cost of Rental
The amount over the cash price you will pay if you make all regular payments.
Payment Due Day*
Enroll in AutoPay?
AutoPay Method

Credit / Debit CardCheckingSavings

Customer Information
RENTER CONTACT INFORMATION
Name*

First NameLast Name
Email*
Cell Phone
Home Phone
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Driver's License #*
State Issue*
Upload D.L. or Gov't ID*

Cancelof
Alternate Contact*
Enter a contact person (spouse or close family/friend) that we can contact about your account.
Relationship*
Phone*
PHYSICAL LOCATION OF LEASED PROPERTY
Same as Mailing Address?*

YesNo
Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Years at Residence*
Own or Rent Home*
Years at Previous Residence
Landlord Name
Landlord Number
Does your D.L. Address Match your Current Address?*

YesNo
Upload Current Utility Bill

If your current address is not the address listed on your D.L., then please upload a current utility bill to verify address.
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Insurance Carrier & Policy #
Enter policy of towing vehicle. Proof required upon approval.
INCOME & EXPENSES
Income Source*
Gross Monthly Income*
Employer or Business Name*
Employer or Business Phone*
Years with Employer or in Business*
Monthly Mortgage or Rent*
CO-RENTER INFORMATION
Add a Co-Renter?*

YesNo
Co-Renter Name

First NameLast Name
Co-Renter Email
Cell Phone
Date of Birth

MonthDayYear
Driver's License
State Issue
Upload D.L. or Gov't ID

Cancelof
Income Source
Gross Monthly Income
Employer or Business Name
Employer or Business Phone
Years with Employer or in Business
AUTHORIZATION
You authorize Tallgrass Leasing LLC ("us") to contact you using any of the phone numbers, emails, or addresses listed in this application.
You authorize us to check and verify all information in this application including, but not limited to, your income, employment history, to obtain a background check, to contact any alternate contact to verify relationship, and any prior accounts with us.
REVIEW & SUBMIT
Please review all information for accuracy. You certify that everything you have stated in this application is true and correct to the best of your knowledge.
By clicking submit below you acknowledge that you have read and agree to the terms and authorizations in this application.
DateTime
Pmt % of Income
Max Cash Price
Should be Empty:

Equipment Details

Lease Details

Customer Information

RENTER CONTACT INFORMATION

PHYSICAL LOCATION OF LEASED PROPERTY

INCOME & EXPENSES

CO-RENTER INFORMATION