EQUIPMENT LEASE APPLICATION

Business Name__________________________________________________________________________________
Address:__________________________________________________City_______________State_______Zip__________
Contact:_________________________________________Title__________________Tele#_________________
Fax#________________________ Your Business Industry:________________________________Fed ID#_______
Type of Ownership: Proprietorship____ Partnership____ Corporation____ LLC____ Years In Business_______

PRINCIPALS OR OWNERS:
Name______________________________________       Name______________________________________
Home Address_______________________________      Home Address_______________________________
City_____________________ST_______Zip_______      City_____________________ST_______Zip_______
Home Phone_________________________________     Home Phone_________________________________
Social Sercuity # ______________________________    Social Sercuity # ______________________________
Title__________________Ownership Percent______%    Title__________________Ownership Percent______%

BANK REFERENCES:
Bank name __________________________________        Bank name __________________________________
City ___________________________St___________      City ___________________________St___________
Checking Acct#_______________________________      Checking Acct#_______________________________
Loan # ______________________________________     Loan # ______________________________________
Officer Name__________________________________     Officer Name__________________________________
Phone Number_________________________________    Phone Number_________________________________

TRADE REFERENCES:
Company Name__________________________________________ Telephone#_____________________________
Contact_____________________________ Acct#_____________________Open Date_______________________

Company Name__________________________________________ Phone #_____________________________
Contact_____________________________ Acct#_____________________Open Date_______________________

Company Name__________________________________________ Phone #_____________________________
Contact_________________________ Acct#_____________________Open Date___________________________

AUTHORIZATION: I hereby authorize the release of all personal or buisness credit or borrowing information requested by New Horizon Business Services or its assigns for the purpose of this lease application. To the best of my knowledge, all information contained herein is accurate and true.