Full Legal Name:____________________________________________________________

Address:___________________________________________Phone:___________________

Years in Business:_______________Type of Business:__________________________

Corp[ ]  Sole Proprietorship[ ]  Partnership[ ] Tax ID#:____________________

Lessee Contact:_____________________________________________________________

1.Officer Name:__________________________Home#:_____________Title:__________

  Address:___________________________________________ SS#:__________________

2.Officer Name:__________________________Home#:_____________Title:__________

  Address:___________________________________________ SS#:__________________
================================VENDOR======================================
Name:_________________________________Contact:______________________________

Address:________________________________Phone:______________________________
===============================EQUIPMENT====================================
Description:________________________________________________________________

Location if different from above:___________________________________________

Total price without tax:$_____________________Lease Term (months):__________
================================= BANK =====================================
(if current account has been open less than 2 years, include previous bank.)

1.Bank:_____________________Phone:____________________Acct#:________________

Contact:____________________________________________________________________

2.Bank:_____________________Phone:____________________Acct#:________________

Contact:____________________________________________________________________
===================================TRADE====================================

Name:____________________Contact:________________________Phone:_____________

Name:____________________Contact:________________________Phone:_____________

Name:____________________Contact:________________________Phone:_____________
============================================================================
RELEASE:  To Whom This May Concern:  This will be your authority and my 
          request for you to release any information requested concerning
          personal or company credit standing.

Signature:__________________________________________Title:__________________
============================================================================