ELEASE Funding Finance Application
Vendor Lead Source
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Vendor Referral
OwnerId
VendorId
Record Type
Company Information
Company Name
*
DBA
Start Date
-
Month
-
Day
Year
Date
Tax ID
Company Phone Number
Please enter a valid phone number.
Company Website
Business Address
*
Street Address
Street Address Line 2
City
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State
Zip Code
Is the equipment location the same as the business address?
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Yes
No
Equipment Location
Street Address
Street Address Line 2
City
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Description
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Contact Information
By adding the following requested information, the undersigned individuals, who are either principals of the credit applicant or personal guarantors of its obligations (individually and collectively, “you”), provide written authorization to Elease Funding Inc. (“eLease”) and each of its representatives, successors, assigns, designees and third-party funding partners, which includes lenders, finance providers and equipment leasing companies with whom eLease has, or may in the future enter into, commercial-brokerage-financing relationships (“Recipients”): (1) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties; (2) to obtain the release, by any creditor, financial institution, or third-party reference (including but not limited to the named entities/references on this application), of any information relating to any of you, to any Recipients, including but not limited to deposit, borrowing and trade information; (3) to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all Recipients for the foregoing purposes; and (4) to contact you via e-mail, call and/or text-message at the e-mail address and/or phone number provided above, or at any e-mail address and/or phone number reasonably identified as belonging to you, including wireless numbers (if applicable), using an automated telephone dialing system or other similar system with respect to this application, future-related commercial-financing opportunities and/or other lawful telemarketing purposes. A photostat or facsimile copy of this authorization shall be as valid as the original. By signature below, (i) you affirm your identities as the respective individual(s) identified in this application as well as (ii) certify that all information and documents submitted in connection with this application are true, correct and complete.
Primary Contact
*
First Name
Last Name
Ownership %
Contact Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
SSN
*
Birthday
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Years at Residence
Do you own your home or rent?
Own
Rent
Monthly Payments
Add an additional Guarantor?
*
Yes
No
G1 Additional Contact
*
First Name
Last Name
G1 Phone Number
*
Please enter a valid phone number.
G1 Email
*
example@example.com
G1 SSN
*
G1 Birthday
-
Month
-
Day
Year
Date
G1 Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Add an additional Guarantor?
Yes
No
G2 Additional Contact
*
First Name
Last Name
G2 Phone Number
*
Please enter a valid phone number.
G2 Email
*
example@example.com
G2 SSN
*
G2 Birthday
-
Month
-
Day
Year
Date
G2 Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Finance Amount
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, age ((provided the applicant has the capacity to enter into a 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. The federal agency that administers compliance with this law is the Federal Trade Commission Equal Credit Opportunity, Washington, D.C. 20580. If 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 contact Lessor set forth above within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.
Vendor
Equipment Description
Cost of Equipment ($)
Equipment Use/Purpose
File Upload - Bank Statements and/or Quotes
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I authorize all deposit, borrowing, and trade information to be released to the Lessor. I hereby represent all information is true, correct and complete. A photo static or facsimile copy of this authorization shall be valid as the original.
*
Yes
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