Please print the following Equipment Lease Application and fax to: 619-220-7028

Business Information Name of Business:______________________________  Business Fed ID #:__________________________ Business Address:______________________________  City / State / Zip:____________________________ Business Telephone #:_________________ Business Fax #:________________  Email:________________ What kind of ownership does the business have? [please select] Corporation / Since:____________ Sole proprietorship    Partnership    Time in Business:______________ Type of Equipment:____________________________________________________________ New or Used? Amount Requested:____________________  Term Requested:  36, 48, 60, 72     Months D&B #:________ Address where equipment will be used:________________________________________________________ Vendor:_______________________________ Contact:_________________________  Phone:___________ Ownership Principal’s Name # 1:__________________________ Title:__________________ Ownership:__________% Home Address:___________________________________________ City / State / Zip:_________________ Home Telephone #:__________________________________  Fax #:_______________________________ Social Security #:_____________  Licensed Doctor? Yes / No     License #:_______ Yrs Licensed:______ Principal’s Name # 2:__________________________ Title:__________________ Ownership:__________% Home Address:___________________________________________ City / State / Zip:_________________ Home Telephone #:__________________________________  Fax #:_______________________________ Social Security #:_____________  Licensed Doctor? Yes / No     License #:_______ Yrs Licensed:______ Bank & Trade Information: Bank Name:___________________________________  Bank Account #:___________________________ Contact Name:________________________  Bank Telephone #:______________ Fax #:_____________ Trade Reference # 1:______________________________ Trade Account #:__________________________ Contact Name:________________________  Bank Telephone #:______________ Fax #:______________ Trade Reference # 2:______________________________ Trade Account #:__________________________ Contact Name:________________________  Bank Telephone #:______________ Fax #:______________ Trade Reference # 3:______________________________ Trade Account #:__________________________ Contact Name:________________________  Bank Telephone #:______________ Fax #:______________ Credit Release: I hereby authorize our banks, trades, and financial institutions to release credit information to Lessor / ISI I further authorize Lessor / ISI to obtain credit information including D&B reports and Credit Bureau reports. ____________________________________________________________       ________________________ Signature                                                                                                  Date