Sygmatech Lease Application

BUSINESS LEASE APPLICATION

Business Application
First Name		Last Name
Business Name
E-mail
Phone*
Address Line 1
	Number*	Street	Street Type
Address Line 2
City		State	Zip*
Business Type
Business Description
Years in Business
Fed ID#

Equipment Information
Description		Purchase Option
Equipment Cost		Term

Guarantor Information
First Name*		Last Name
Social Security Number
Address Line 1
	Number	Street	Street Type
Address Line 2
City		State*	Zip

Bank Reference
Bank Name*
Account #
Phone*
Contact
Date Acct. Opened?

Trade Reference
Trade Name
Account #
Phone
Contact

Trade Name
Account #
Phone
Contact

Lease Reference
Lease Name
Account #
Phone
Contact
Date Acct. Opened?

Lease Name
Account #
Phone
Contact
Date Acct. Opened?

By electronically submitting this lease application, I/we certify that the information provided herein is accurate and complete. I/we hereby authorize Sygmatech US Ltd., or any of its agents or lessors, which may be utilized to investigate my/our credit/financial information pertaining to above accounts.

For questions or help please call (800)570-5327.