ISI Leasing Information and Application Form

Lease and Rental Programs
We offer many creative financing packages. We have rent, rent-to-own, lease, and purchase options available.  Additionally, custom leases can be created to fill almost any need and meet any budget.  If you have an unusual request, just ask; chances are we have satisfied the same request before.

 

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
 

contact us: sale@c-arm.com

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Imaging Services is not affiliated in any way with and is not an authorized dealer of OEC Medical Systems, Inc. The OEC products sold by Imaging Services have been remanufactured by Imaging Services. No products sold by Imaging Services are warranted by OEC Medical Systems, Inc.

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