Lease Application
(Note: The "Authorization to Obtain Credit Information" MUST be completed
and faxed to DeGroot Leasing Company for this Application to be considered.
The link for the Authorization is at the bottom of this Application.)
    Applicant Information

Business Name:

Street Address:

City:

State:

  Zip Code:

Telephone Number:

   Fax Number:

E-mail Address:

Tax ID Number:

Time in Business:

  Type of Business:

Contact:

Corporation:  Partnership:  Proprietership: LLC:
   Officers or Owners
  Name 1
  First:  Last:  % Ownership:
  Title: Social Security # : Tel:
  Address:
  City: St: Zip:
  Name 2
  First:  Last:  % Ownership
  Title: Social Security # : Tel:
  Address:
  City: St: Zip:
  Name 3
  First:  Last:  % Ownership
  Title: Social Security # : Tel:
  Address:
  City: St: Zip:
     Bank References
  Bank 1
  Name:   Branch: 
  Acct #: CH: SV: LN:   Officer: Tel:  
  Fax:     
  Bank 2
  Name:   Branch: 
  Acct #: CH: SV: LN:   Officer: Tel:  
  Fax:     
     Credit References/Trade
  Ref #1:   Tel:
  Fax:     Ask for:
  City, State, Zip:
  Ref #2:    Tel:
  Fax:      Ask for:
  City, State, Zip:
  Ref #3:    Tel:
  Fax:      Ask for:
  City, State, Zip:
     Equipment & Dealer Information

  Equipment to be Leased:
  

Dealer:
Address:
City: State: Zip:
Dealer Tel: Dealer Fax:
Dealer Salesperson:
E-Mail:
Equip. Cost: Lease Term: Residual:

Equipment Location
Address:
City: State: Zip:

Additional Comments:

The "Authorization to Obtain Credit Information" MUST be completed and Faxed to DeGroot Leasing Company for this application to be considered.

Click here to View & Print the Authorization


 

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All Rights Reserved

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