Vendor Finance Group On-line Application
18201 Von Karman Avenue, Suite 800
Irvine, CA 92612
Phone: (800) 496-4640, ext. 512 - Fax: (949)255-0501

We welcome the opportunity to provide you a quote on your leasing needs. Please complete this lease application form and either send it to us or print it and fax it to (949)255-0501.

Lessee (complete legal name of entity):
Organization Name:
Address:
City:
State: Zip:
Phone: ( ) -
Fax: ( ) -
Type of Business:

Nature of Business:
Years in Business:
Contact Person:
Name: Title:
email: Fax: ( ) -
Phone: ( ) -    
Equipment Information:
Equipment Description:
Total Equipment Cost ($):
Initial Lease Term Requested:
24 Months
30 Months
 36 Months
48 Months
End of Term Purchase Option: Fair Market Value (FMV)
10% Purchase Option
$1 Buyout
*For more than $100,000 quote, please call (800) 496-4640 ext. 512.
Vendor Information:
Vendor Contact:
Vendor Phone: ( ) -
Reseller/Distributor Information (If applicable):
Reseller/Distributor Name:
Reseller/Distributor Contact:
Reseller/Distributor Telephone:
Bank/Trade References:
  Bank: Trade or Finance References:
  Account #1 Account #1 Account #2 Account #3
Name:
Street:
City:
Phone No:
Type Acct:
Acct. No:
Contact:
Credit Information Release:

I/We understand that I/we may submit my application to Vendor Finance Group electronically by clicking "Submit Application" below, or I/we may submit the application by fax or mail.

I/We authorize you to make such inquiries regarding the information furnished herein as may be required in connection with the application or in the course of review of any credit extended in reliance on the application. All information set forth in this application is a truthful and accurate representation of facts for the purpose of obtaining the lease financing requested by me/us. If I/we choose to submit this application electronically, I/we acknowledge that Vendor Finance Group is unable to ensure that the data cannot be intercepted by third parties. In submitting this application electronically I/we knowingly and voluntarily agree that Vendor Finance Group will not be held liable in any manner whatsoever should such interception occur.

I/We understand that other financial information may be requested in connection with this lease application.

Yes    No

 

Thank You for your interest

Vendor Finance Group
18201 Von Karman Avenue, Suite 800
Irvine, CA 92612
Phone: (s800) 496-4640, ext. 512 - Fax: (949) 255-0501