Owner / Applicant Information

Legal Business Name / Owner: Legal Business Name / Owner:

Address: Address:

City: City:

Zip Code: Zip Code:

Type of Business: Type of Business:

Phone Number: Phone Number

Fax Number: Fax Number:

Email Address: Email Address

Fax Tax Number: Fax Tax Number:

Date Established / Time in Business: Date Established / Time in Business:

Owners

Name 1: Name 1:

Address: Address:

City: City:

Zip Code: Zip Code:

SSN: SSN:

Phone: Phone

% of Ownership: % of Ownership:

Name 2: Name 2:

Address: Address:

City: City:

Zip Code: Zip Code:

SSN: SSN:

Phone: Phone

% of Ownership: % of Ownership:

Farm

Land (Acres)

Rented: Rented:

Owned: Owned:

Farm Gross Annual Income: Farm Gross Annual Income:

Other Income: Other Income:

Livestock 1

Head: Head:

Type: Type:

Livestock 2

Head: Head:

Type: Type:

Assets & Liabilities Information

Assets

Cash on hand / in bank: Cash on hand / in bank:

Total Assets: Total Assets:

Liabilities

Total Liabilities: Total Liabilities:

Owners Equity: Owners Equity:

Vendor / Equipment Information

Name: Name:

City: City:

Description of Equipment to be Leased: Description of Equipment to be Leased

Phone Number: Phone Number

Contact: Contact:

Lease Terms

Name: Name:

Down Payment / Trade: Down Payment / Trade:

Total Cost: Total Cost:

By clicking on the "Submit Application" button, the undersigned authorizes and instructs any person, consumer reporting agency or bank institution to compile and furnish the lessor with any information it may have in response to any inquiry from the

All information in this application and all attachments is correct to the best of my knowledge. I authorize verification of employment and all financial and other information submitted with this application, including obtaining a credit report, to act on this application. I authorize making continued inquiries about such information and obtaining a credit report during the term of my lease(s) as necessary to administer my lease(s). As required by law, my identity will be verified. I authorize all past or present creditors to release any and all necessary credit information, and to respond fully to requests for information based on this application when transmitted by electronic or other means. I authorize any lessor making a lease applied for hereby to disclose to you, on a confidential basis, my personal, credit and other information (including without limitation post-closing information regarding the servicing of the lease and any defaults thereunder), whether or not you are a servicer of the lease. The above permissions and authorizations will apply to any creditor to whom this application is submitted. I certify that the lease(s) applied for hereunder are for business, commercial or agricultural purposes and not for personal, family or household purposes. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant?s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. A number of federal agencies share enforcement responsibility for this law. Determining which agency to contact depends on the type of creditor you dealt with. Consult the creditor to whom this application is addressed for information on its regulator, or contact The Federal Trade Commission, Consumer Response Center, Washington, D.C. 20580, 1-877-382-4357.

Authorized Signer: Authorized Signer:

Second Authorized Signer: Second Authorized Signer:

Title: Title:

Second Signers Title: Second Signers Title: