Transportation/Title Equipment Application

Vendor Information
Name:
Address:
City:
State:
Zip:
Phone:
Federal ID:
Email Address:

How did you hear of triconleasing.com?

Lessee Information
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Years in Business:


Officers/Owners (if corporation, list president)
Name:
Title:
Social Security #:
Address:
City:
State:
Zip:
Phone:

Name:
Title:
Social Security #:
Address:
City:
State:
Zip:
Phone:


Bank Account Information (Provide 2 year history)
Bank Name:
Contact Officer:
Account Number:
Phone:


Trade References

Trade #1
Name:
Contact:
Phone:

Trade #2
Name:
Contact:
Phone:

Loan/Leasing Reference
Name:
Contact:
Account Number:
Phone:
Email:
Contact Fax:


Equipment Description
List Description:
Months Desired:
Equipment Cost:


Fee Payment Information
Name on Card:
Card #:
Expiration Date:
CCV:
Amount:
Signer's Name:


Bank Disclosure Statement
 
The undersigned authorizes full disclosure of information pertaining to his/her business account(s) with your institution. Please communicate such information to TRICON LEASING GROUP, LTD., and or its assigns. We, the company, will hold the bank harmless in releasing such information whether by fax, or by other common means as the bank may dictate.

Type your Full Name
for use as a signature:

  Accepted As Digital Signature