Direct Source Capital

Direct Source Capital Commercial Lease Application * Required Fields
Account Executive

*Lessee Full Company name	*Date of Current Ownership		*Lessee Contact

*Lessee Billing address	*City	*State		*Zip

*Telephone	*Fax	E-mail

DBA	Federal Tax No.

*Type of Business If other, please indicate:
Structure If Corporation, indicate in which state you are incorporated:

Guarantors / Owners	_1_*	(2)	(3)
*Name
*Street
*City, State, Zip
Home Number
Social Security Number
*Title
*% Of Ownership

Credit References
*Bank	City/State	*Phone Number	Contact	*Account Number


Please Note Additional Bank References at Bottom.
Bank Loan, Lease or Finance References:	City/State	Phone Number	Contact	Account Number


Please Note Additional Loan, Lease or Finance References at Bottom.
Major Trade Accounts:	City/State	Phone Number	Contact	Account Number

Please note Additional Trade References at Bottom.

Seller of Equipment:

Seller's Company Name

Address

City

State

Zip

Contact

Phone Number

Fax Number

E-mail

*Equipment Description

New

Used

*Equipment Location (If Different From Address Above)

Term Requested

Installation Date

Lease Buyout Request (10%, FMV ...)

Total Equipment Cost

If other, please specify:

Additional Bank, Lease, Loan, Finance or Trade Reference or Other Pertinent Information or Comments:

Credit Release
The undersigned indiv. (either a principal of the credit applicant or a guarantor of its obligations) provides this written instruction to Lessor or its nominee/assigns authorizing review of his/her pers. credit profile from a nat’l credit bureau. Such authorization shall extend to obtaining a credit profile in consideration of this application and subsequently for the purpose of update, renewal or the extension of such credit and for reviewing and collecting the resulting acct. A photostat or facsimile of this auth. shall be valid as the original. By signing below, I/we affirm our identity as the respective individuals identified in the related application. The undersigned states that all of the above statements are true & complete and authorizes Lessor to obtain from any source information re: the credit standing of the applicant or guarantors.

Title

Date

DSC may require Credit Authorization Form to be signed for credit releases to bank and trades.

Direct Source Capital Commercial Lease Application