Camrose Leasing Ltd.

Company Information

Legal Company Name:
Operating As:
Contact:
Address:
City:
Province/State:
Country:
Postal/ZIP Code:
Phone (with area code):
Fax (with area code):
Mobile (with area code):
Email:
Website:
Nature of Business:
# of Employees:
Business Start Date:
Average Monthly Income:
Reason for Equipment Acquisition:

Incorporated Partnership Proprietorship

Principal / Personal Information

First Name:
Last Name:
DOB :
S.I.N. No.:
Address:
City:
Province/State:
Country:
Postal/ZIP Code:
For How Long:

Ownership:

Value:
Mtg. Balance:
Previous Employment:
For How Long:

Secondary Ownership Information (if applicable)

First Name:
Last Name:
DOB :
S.I.N. No.:
Address:
City:
Province/State:
Country:
Postal/ZIP Code:
For How Long:

Ownership:

Value:
Mtg. Balance:
Previous Employment:
For How Long:

Bank Information

Bank Name:
Branch:
Address:
City:
Province/State:
Country:
Account #:
Contact:
Phone:
How long at this bank:

Trade/Credit Reference #1

Company Name:
Contact:
Phone:

Trade/Credit Reference #2

Company Name:
Contact:
Phone:

Trade/Credit Reference #3

Company Name:
Contact:
Phone:

Equipment to be Leased

Cost of equipment:
Description including Year, Make, Model, etc.:
Vendor:

Term Information

Length of term:
Buyout option:

Which representative have you been dealing with ?

How would you like to submit this form ?

Terms and Conditions ?

I certify the above information to be true and correct. I consent to Lease Link Financial Corporation and/or its credit grantors obtaining from any credit reporting agency, such information as it may require at any time in connection with the credit hereby applied for, and consent to the disclosure at any time of any information concerning myself and/or my company to any credit reporting agency or to any credit grantor with whom I or my company has financial relations.

I have read and agree to the Terms and Conditions