Lease application


Complete as much of this lease application as you can. We will contact you for any additional information that we need. If you would prefer to provide this information over the telephone, enter your company and contact information and someone from Premier will call you back promptly. Two or more years time in business required.



Company Information
Legal Name
*
Time in Business

DBA

Tax ID

Company Type
Address
Address

Address

City

State

Zip

Contact
First
Last
*
Email
*
Phone
*
Mobile

Fax


Business Checking
Bank Name

Account Number

Contact

Phone


Equipment Needed
Type of Equipment

Type of Equipment
New         Used
Amount Required
$
Equipment Vendor

Vendor Contact

Vendor Phone

Owner 1
Name

Title

SSN

Percent ownership
%
Address

City

State

Zip

Owner 2
Name

Title

SSN

Percent ownership
%
Address

City

State

Zip


* are required fields
If you are working with a Premier agent or affiliate, enter their name here:



Once this application has been submitted and received by Premier Funding Services, LLC a representative from our team will review the information and call the designated contact person for verification purposes and to gather any additional information needed. Premier Funding Services will not pull your credit report until you authorize us in writing to proceed. Application data is not shared or resold to third parties of any kind for the purpose of unsolicited marketing. Data is kept confidential at all times.