Professional Leasing Source, Inc.

Lease/Finance Application Form

Business Information *

Owner Information *

Owner Address is the same as Business Address above.

Co-Owner or Co-Signor Information (if applicable)

Equipment Information *

Please select the type of equipment you intend to lease/finance.

Amount to be Financed? *

Please select how much you are intending to finance.

Sales Representative?

I hereby authorize Professional Leasing Source, Inc., its designee, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and also for the purpose of updating, renewing, extending additional credit or the collection of any late account. I hereby authorize our references to release all credit information. I represent and warrant that the information submitted herein is true, complete and accurate. A facsimile, electronic or other copy of this authorization shall be as valid as the original.

By checking the box below, I agree with the Authorization above and that the information herein is true and correct.

YES