Business Lease ApplicationFinancing provided by Unisource Capital Step 1 of 4 25% Step 1: Complete the application to the best of your ability. Step 2: UniSource processes your application, and responds to you within 24 hours. Step 3: If credit is approved, UniSource will call you to discuss terms and payments. Step 4: UniSource will prepare your lease documents, and overnight them to you. Step 5: You sign and return the lease documents to UniSource. Step 6: Unisource receives your signed lease documents. Step 7: You receive your equipment. Unisource will call to verify that everything is delivered.Equipment / Supplier InformationEquipment SupplierPhoneEquipment Supplier ContactEquipment LocationEquipment Brand & Model #Equipment CostPlease enter a number greater than or equal to 1400.Lease Term (24-60 months)Please enter a number from 24 to 60. Business InformationBusiness Name*Years in Business Under Current OwnershipTitleFirst Name*Last Name*Email* Work Phone*Mobile PhoneFaxAddress* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Person Signing LeasePerson Signing TitleNature of Business Owner / Stockholder InformationTitleFirst NameLast NamePhoneEmail Address Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Percent OwnershipSSNIs there more than one Owner?NOYESAdditional Owner / Stockholder InformationTitleFirst NameLast NamePhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Percent OwnershipSSN Business Bank ReferencesReferenceReference ContactReference PhoneReference SinceReference Account TypeI hereby authorize UniSource Capital or its assigns to make a complete credit check on our company and the principals to the same as individuals and to relate this information to others as necessary to secure credit approval. I also authorize the above references to release any information that may be requested by UniSource Capital. I certify this statement is true and accurate.