MidWest Leasing and Finance Credit Application


To download the Adobe Acrobat PDF Application [ CLICK HERE ] , then print and fax.

APPLICATION TYPE:
APPLICANT
Customer
Address:
   
City:
State:
    
Zip:
Phone:
    
Cell:
Fax:
   
Contact:
Date Started:
    
Year Incorporated:
Corporation:
 S-Corp C-Corp LLC Partnership Proprietor  
Nature of Business:
PRINCIPAL
Name:
Title:
Social Security #:
Home Address:
City:
 
State
Zip:
Home Phone:
EQUIPMENT
Equipment:
Terms:
 Months  
Purchase Option:
  
Advance Payments:
  
Cost w/o Tax:
  
BANK
Bank Name:
Account #:
C: S: L:
Town Located:
Bank Officer:
Phone:
Bank Name:
Account #:
C: S: L:
Town Located:
Bank Officer:
Phone:
TRADES
Name:
Contact:
Phone:
Name:
Contact:
Phone:
Name:
Contact:
Phone:
Name:
Contact:
Phone:
INSURANCE
Ins. Agency:
Contact:
Phone:
DEALER
 
Vendor:
Address:
City:
 
State:
Zip:
 
 
Phone:
Contact:
 

Applicant represents and warrants that all credit and financial information is true and correct and authorizes above named creditors to release any information to Midwest Leasing and/or any prospecting creditor.