Manual Entry | Aztec Leasing

1. APPLICANT INFORMATION

Customer Legal Name *

Address *

City *

State *

Zip *

Phone *

Email Address *

Federal I.D. (EIN) *

Business Details

Entity Type *

Year Incorporated *

State Incorporated *

Year Started *

Years Owned *

2. EQUIPMENT DETAILS

Manufacturer *

Make / Model *

Options

Payment Details

Term (Months) *

Payment Amount *

Equipment Type *

Payment Frequency *

3. OWNERSHIP INFORMATION

Principal #1

Name *

Title

% Owned *

Address

City

State

Zip

Principal #2 (Optional)

Name

Title

% Owned

Address

City

State

Zip

4. FINANCIAL REFERENCES

Bank Reference

Bank Name

Contact

Phone

Finance Reference (Optional)

Company

Collateral

Contact

5. VENDOR INFORMATION

Vendor Name

Contact Person

Phone/Email

Aztec Leasing