Complete Legal Company Name: 

                     Phone #  FAX#
              Contact email: 

            Mailing Address:  
                       City:  State: ZIP: County: 

           Date Bus.Started:  Years Under Same Ownership:
         Equipment Location: 

            Business Nature: 
Type Of Business (Check One):Corporation Partnership Proprietorship Municipality Nonprofit LLC

Any Other Business Names Used? Yes No If so, please specify:

Federal I.D. No.:    Date of Incorporation: D&B No.:

OFFICERS/OWNERS/PARTNERS: (Those authorized to sign lease.)  Social Security Number Required!



Full Name 

Title

%Owned 

Home Address

Soc.Sec. #


Principal #1


 

 


 



Spouse


 

 


 



Principal #2


 

 


 



Spouse


 

 


 




Has any Owner/Officer filed Bankruptcy in the last 10 years? Yes No

BANK REFERENCES:  (To support time in business, please list previous Bank(s),
                  if applicable.)  Acct. # is Required!



Bank Name

Phone #

Acct. # (List All)

Contact

Type Account

























TRADE REFERENCES:  (3 MAJOR Trades vital to daily operation of business 
                   that you have a long-standing relationship with)



Company Name

Phone #

Acct. #

Contact


















EQUIPMENT TO BE LEASED:



QTY.

New/Used(Age)

Description

Model #

Price(w/o Tax)

Term Requested
























VENDOR: Name: 

     Address: 
      Phone #   FAX #  Contact:

Do you represent that all information provided with this Application is true and correct and
hereby authorize A.S.T. Financial Corp to obtain from third parties information Lessor deems
necessary to arrive at a decision regarding this Application?  Yes No

By checking the appropriate box below do you also authorize A.S.T. Financial Corp, its designee,
assigns or potential assigns, to review your personal credit profile provided by national credit
bureaus in considering this Application for the purpose of the update, renewal, or extension of 
credit to the Application or the collection of any resultant accounts?  Yes No

Name of authorizing individual:  Date: