Payment Estimator
Lease Financing Administered Through
21ST Century Leasing
2505 Congress St. Suite: 100
San Diego, CA 92110
800.550.4966 

Commercial Lease Application

Vendor Information
Vendor Name: Equipment Description:
Vendor Address: Equipment Cost:
City, State, Zip: Contact:
Vendor Phone: Vendor Fax:
 
Business Information
Business Name: Business Phone:
Nature Of Business: Business Fax:
Business Address: *Email:
City, State, Zip: Years In Business:
Type Of Business: *Valid Email Required  
 
Personal Information
Principal #1
Name: Home Phone:
Home Address: Own Home:
City, State, Zip: SSN#:
 
Principal #2
Name: Home Phone:
Home Address: Own Home:
City, State, Zip: SSN#:
 
Bank Information
Primary Bank
Name/Branch: Checking Account#:
Bank Contact: Savings Account #:
Bank Phone: How Long:
 

CREDIT AUTHORIZATION AND RELEASE

I hereby certify: (i) the information provided is true and correct. (ii) You are hereby authorized to investigate all bank, credit, and trade references, and said references are hereby authorized to release any requested information to you or your nominee, (iii) such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purpose of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account, (iv) this information may be transmitted by us to you and to underwriter(s) for the purpose of granting to me credit, either electronically or manually, and that by submitting this application, I take full responsibility for transmission thereof, (v) I am over eighteen years, (vi) I acknowledge my rights under the Fair Credit Reporting Act, and (vii) this request is for business and not for consumer purposes.