Paramount Leasing Ltd.

3665 Kingsway, Suite 300

Vancouver, British Columbia  V5R-5W2

Tel:(604)630-3077  Fax:(604)435-8181

 Equipment Lease

Application

 

Date __________________

 

Paramount Leasing Ltd.

3665 Kingsway, Suite 300

Vancouver, British Columbia  V5R-5W2

Tel:(604)630-3077  Fax:(604)435-8181

 

LESSEE (Complete legal name of entity.  If corporation, use EXACT registered corporate name.)

Company

 

DBA

Billing Address                                                           City                                              County                                 State                 Zip

 

Telephone No.

                                                                       

Contact Person                  q Mr.         q Mrs.       q Ms.               Title                      Fed. Tax ID #

 

Nature of Business

 

Type of Business:  q Proprietorship  q Corp (Registered in State of________)

                 q Partnership q Non-Profit Corp (Registered in State of________)

No. Years in Business

(present ownership)
       

PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS

Name

 

Title

% Ownership

Social Security No.

Home Address                   Homeowner?  q Yes  q No              City                                State                 Zip

Home Phone No.

 

Name

Title

% Ownership

Social Security No.

 

Home Address                   Homeowner?  q Yes  q No              City                                State                 Zip

Home Phone No.

 

TRADE AND/OR LEASE REFERRENCES – TWO YEAR HISTORY

Name of Supplier

 

City/State

Telephone No.

Contact Person

Name of Supplier

 

City/State

Telephone No.

Contact Person

Name of Supplier

 

City/State

Telephone No.

Contact Person

COMPANY BANK REFERENCES – TWO YEAR HISTORY

Name of Bank/Branch              City/State

 

Checking Acct. #

Telephone No.

 

Contact Officer

Loan Acct. #

Name of Bank/Branch              City/State

 

Checking Acct. #

Telephone No.

 

Contact Officer

 

Loan Acct. #

EQUIPMENT TO BE LEASED (Attach separate list if necessary.)

Description (include make, model & serial numbers and any attachments.)

 

Equipment Cost

Description (include make, model & serial numbers and any attachments.)

 

Equipment Cost

Location Where Equipment is to be Installed

 

Yrs. Co. At this Location

VENDOR INFORMATION

Vendor’s Name

 

Vendor Code

Contact

Telephone #

Fax #

Street                                                                                City                                                               State                                     Zip

 

PAYMENT PLAN

Term in Months

 

No. of Payments to Start

Security Deposit

Buy-Out Amount

 $1.00   10%   FMV   10% PUT   TRAC

INSURANCE CARRIER

Agent Name

 

Policy #

Phone #

Fax #

ACKNOWLEDGEMENT AND AUTHORIZATION

By signing below, each undersigned person, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Gallant Funding, Inc. (or its designee or assignee thereof) authorizing review of their personal credit file from a national credit bureau.  Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purposes of update, renewal or extension of such credit and for reviewing or collecting the resulting account.  A photo-stat or fax copy of this authorization shall be valid as the original.

 

_____/_____/_____By: X_____________________________________   _____/_____/_____By: X_____________________________________

 (mm  /  dd    /  yyyy)                                                                                     (mm  /  dd    / yyyy)

  
 

 

PERSONAL APPLICATION

 

                                     

COMPANY INFO

FULL COMPANY NAME

ABOUT YOURSELF

LAST NAME:

FIRST NAME:

INITIALS:

SOCIAL INSURANCE NO:

DATE OF BIRTH (DD/MM/YYYY):

DRIVERS LICENCE NO:

ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

HOW LONG?

PREVIOUS ADDRESS (if less than three years at present address):

CITY:

PROVINCE:

POSTAL CODE:

HOW LONG?

CURRENT RESIDENTIAL ADDRESS

  OWN          LIVE WITH PARENTS

  RENT         OTHER

MONTHLY RENT/MORTGAGE:

$

LANDLORD/MORTGAGEE:

TELEPHONE:

(      )

ABOUT YOUR WORK

EMPLOYER:

POSITION:                                                          GROSS MONTHLY:                HOW LONG?

                                                         $

PREVIOUS EMPLOYER (if less than 2 years above):

 

POSITION:                                                          GROSS MONTHLY:                HOW LONG?

                                                         $

ABOUT YOUR FINANCES

 

ASSETS

VALUE

LIABILITIES

PAYMENT

BALANCE

REAL ESTATE

HOME

$

MORTGAGE

$

$

REAL ESTATE

Specify

$

MORTGAGE

$

$

OTHER

Specify

$

OTHER

$

$

Vehicle (1)

Year & Make

$

LOAN

Specify

$

$

Vehicle (2)

Year & Make

$

LOAN

Specify

$

$

CASH

$

CREDIT CARD

$

$

RRSP

$

OTHER DEBT

$

$

STOCKS, BONDS, ETC

With

$

PERSONAL GUARANTEES?

$

$

MISC.

Specify

$

TOTAL LIABILITIES:

$

$

TOTAL ASSETS:

$

 

NET WORTH

$

ABOUT YOUR SPOUSE

LAST NAME:

FIRST NAME:

INITIALS:

DATE OF BIRTH (DD/MM/YYYY):

SOCIAL INSURANCE NO:

TITLE:                               HOW LONG?

EMPLOYER:

OCCUPATION:

GROSS MONTHLY:

HOW LONG?

CREDIT CARDS:

PERSONAL REFERENCES

NAME:

ADDRESS:

TEL:

NAME:

ADDRESS:

TEL:

AUTHORIZATION

BY SIGNING BELOW, I/WE CERTIFY THAT THE STATEMENTS PROVIDED ARE TRUE AND COMPLETE. I/WE (“THE APPLICANT AND CO-APPLICANT”) HEREBY CONSENT TO AND AUTHORIZE PARAMOUNT LEASING LTD.  AND/OR IT’S AFFILIATES TO USE THE INFORMATION ABOUT ME/US AND THE BUSINESS AS IT MAY REQUIRE TO APPROVE THE CREDIT HEREBY APPLIED FOR AND FOR THE PURPOSES OF CONDUCTING A CREDIT INVESTIGATION INCLUDING SUCH REQUESTS FOR INFORMATION FROM CONSUMER REPORTING AGENCIES OR CREDIT GRANTORS AS IT MAY REQUIRE TO APPROVE THE CREDIT HEREBY APPLIED FOR.

 

PLEASE SIGN BELOW

 

X                                                                                                                        DATE

(Applicant)

 

X                                                                                                                                     DATE

(Co-Applicant if applicable)

 
                               

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