Envision Capital Group
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Equipment Lease Application
 
 

 
Lessee Company Information
Company Name
 
   		Email
Company Address


 		 City


 		 State


 		 Zip
Signer

 		 Title
 Telephone #
 
Federal Tax ID

 		 Fax #
 
Type of Business
# of Employees
# of Years in Business
Information on Officers, Partners or Guarantors
Name


 		 Title


 		 SSN


 		 % Ownership
Home Address


 		 City
 State
 Zip
Home Phone #
      
 
Name


 		 Title


 		 SSN


 		 % Ownership
Home Address


 		 City
 State
 Zip
Home Phone #
      
Company Bank References
Name of Bank/Branch 1

 		 How Long?


 		 Checking Account #
Telephone #




 		 Contact Officer


 		  
Name of Bank/Branch 2

 		 How Long?
Checking Account #
Telephone #
 Contact Officer
  
Trade Reference - Two Year History
Name of Supplier

 		 City/State
 Telephone #
Contact Person
Name of Supplier
City/State
 Telephone #
Contact Person
Lease/Loan References
Name
 Original Amount


 		 Loan Account #
Contact Person
Telephone #
 
Equipment Information
Equipment Vendor:
Equipment Description (Make, Model, Year)
Equipment Cost
Declaration
I/We understand that I/We may submit my application to Envision Capital Group Corporation electronically by clicking "Submit Application" below, or I/We may submit the application by fax or mail. I/We authorize Envision Capital Group Corporation to make such inquiries regarding the information furnished herein as may be required in connection with the application, or in the course of review of any credit extended in reliance on the application, such as obtaining individual credit bureau reports, Dun & Bradstreet business reports, and/or other credit reports/references. I/We represent that all information set forth in this application is a truthful and accurate representation of facts for the purpose of obtaining the lease financing requested by me/us. If I/We choose to submit this application electronically, I/We acknowledge that Envision Capital Group Corporation is unable to ensure that the data cannot be intercepted by third parties. In submitting this application electronically I/We knowingly and voluntarily agree that Envision Capital Group Corporation will not be held liable in any manner whatsoever should such interception occur. I/we understand that other financial information may be requested in connection with this lease application, and that this application is not an offer to extend credit.
Applicant
 Title
 Date

 
Applicant
 Title
 Date



Do you agree and accept terms?   I agree.   I do not agree.

 
* Please push the "Submit" button ( 1 ) one time and wait for a confirmation.

 

  

ENvision Capital Group LLC.   5140 Birch Street, 2nd Floor  Newport Beach, CA 92660.   949-225-1700
2006-2007 Envision Capital Group LLC  for all your Equipment Lease needs.