EQUIPMENT LEASE APPLICATION FORM

CUSTOMER                                                                                     Phone No.                                  

Address                                                                                                                                      

                           Street                                             City                              State                 Zip 

Owner(s)                                              US Citizen?   Yes         No       Social Sec. No.                           

                                                           US Citizen?   Yes         No       Social Sec. No.                          

Nearest Relative not living with you                                              Phone No.                                      

Nature of Bus.                                      Years in Bus.                   Federal ID No.                                  

Corporation                    State of Inc.             Proprietorship                           Partnership                     

EQUIPMENT DESCRIPTION

Equipment Description                                                                                                               

New                    Used               

Cost ($ w/o Tax)                             Term                                             Payment Amount   $                

Factor                                           Purchase Option                            Tax Amount $                

Advanced Payments                       Security Dep.                                Total Payment $                 

CREDIT LIFE & DISABILITY INSURANCE OPTIONS  

___ NO, I do not want credit life & disability insurance coverage for my lease obligation.

___ YES, I want credit life insurance coverage for the person(s) named above as “Customer” & I also want credit disability insurance coverage for the person whose name appears first as “Customer” on this application.  The credit insurance coverage will only go into effect if this lease application is approved by Stearns Bank and the age and health of the applicant(s) qualify for the insurance.   CREDIT LIFE INSURANCE, CREDIT DISABILITY INSURANCE AND CREDIT INVOLUNTARY UNEMPLOYMENT INSURANCE ARE NOT REQUIRED TO OBTAIN CREDIT.  YOU MAY BUY INSURANCE FROM ANYONE YOU CHOOSE OR YOU MAY USE EXISTING INSURANCE. 

TRADE REFERENCES

Name:                                          

City/State:                                

Ph:                             

Name:                                        

City/State:                                

Ph:                              

Name:                                       

City/State:                                

Ph:                              

BANK REFERENCE/RELEASE FORM

Bank                                                                         Attention                                            

Address                                                  City                            State       Zip                               

Ph #                                         Fax #                                    Customer Name                                

Account Number(s) #                                      #                                        #                                 

Ocean Machinery's Leasing Company will be requesting information by telephone on all accounts maintained at your bank.

Please sign this release as authorization to provide the requested information. 

X                                                                                  Date