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Lease Application

Are you ready to get started saving money today? Simply fill out the form below and we will contact you soon.

The "Authorization to Obtain Credit Information" MUST be completed and sent back (e-mail or fax) to DeGroot Leasing Company for this application to be considered.

* The link for the Authorization is at the bottom of this application.

APPLICANT INFORMATION

Business Name
Street Address
City
State  Zip Code 
Telephone Number  Fax Number 
E-mail Address
Tax ID Number
Time in Business  Type of Business 
Contact
Corporation  Partnership  Proprietership LLC

OFFICERS OR OWNERS

Name 1
First  Last  % Ownership 
Title  Social Security #   Tel 
Address 
City  State  Zip 
Name 2
First  Last  % Ownership 
Title  Social Security #  Tel 
Address 
City  State  Zip 
Name 3
First  Last  % Ownership 
Title  Social Security #  Tel 
Address 
City  State  Zip 

BANK REFERENCES

Bank1
Name  Branch  
Acct #  CH  SV  LN 
Officer  Tel   Fax 
Bank2
Name  Branch  
Acct #  CH  SV  LN 
Officer  Tel   Fax 

CREDIT REFERENCES/TRADE

Ref #1   Tel 
Fax  Ask for 
City, State, Zip 
Ref #2   Tel 
Fax  Ask for 
City, State, Zip 
Ref #3   Tel 
Fax  Ask for 
City, State, Zip 

EQUIPMENT & DEALER INFORMATION

Equipment to be Leased

Dealer 
Address 
City  State  Zip 
Dealer Tel  Dealer Fax 
Dealer Salesperson 
E-Mail 
Equipment Cost  Lease Term  Residual 

Equipment Location
Address 
City  State  Zip 

Additional Comments

The "Authorization to Obtain Credit Information" MUST be completed and sent back (e-mail or fax) to DeGroot Leasing Company for this application to be considered.

Click Here to View & Print the Authorization