accordfg.com | Equipment Leasing & Financing | Commercial

Equipment Leasing & Financing

Production Energy Services has partnered with Accord Financial Group to provide financing on equipment for their customers. Please call Staci at 800-347-4977 or email her at staci@accordlease.com if you have any questions about their programs. If you know the equipment you will be getting and would like to apply for credit, please complete the secured application below.

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Lessee / Applicant Information

Legal Business Name / Lessee: Legal Business Name / Lessee:

Address: Address:

City: City:

State:

Zip Code: Zip Code:

County: County:

Type of Business: Type of Business:

Ownership:

Sales Tax Exempt?:

Federal ID#: Federal ID#:

Phone Number: Phone Number

Fax Number: Fax Number:

Cell Number: Cell Number

Contact: Contact:

Email Address: Email Address

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

Annual Gross Revenues: Annual Gross Revenues:

Equipment Location (if different from above): Equipment Location (if different from above):

Best way to communicate with you:

Principal Information (President, Owner or Partners)

Name 1: Name 1:

Address: Address:

City: City:

State: State:

Zip Code: Zip Code:

SSN: SSN:

Home Phone: Home Phone

% of Ownership: % of Ownership:

Name 2: Name 2:

Address: Address:

City: City:

State: State:

Zip Code: Zip Code:

SSN: SSN:

Home Phone: Home Phone

% of Ownership: % of Ownership:

Vendor / Equipment Information

Vendor: Vendor:

Vendor Address: Vendor Address:

Vendor City and State: Vendor City and State:

Vendor Zip Code: Vendor Zip Code:

Description of Equipment: Description of Equipment:

Total Cost (w/o tax): Total Cost (w/o tax):

Vendor Phone Number: Vendor Phone Number

Contact: Contact:

Terms (months): Terms (months):

Equipment Condition:

Who are you working with at Accord?:

Authorization

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

Authorized Signer: Authorized Signer:

Second Authorized Signer: Second Authorized Signer:

Title: Title:

Second Signers Title: Second Signers Title: