Commercial Leasing Application

Business Information

Business Name Date of Establishment Tax ID Number Business Phone Number Business Fax Number

Business Type Sole Proprietor Corporation Partnership LLC Non-Profit Other

Business Type Street Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Business Principal

First Name Middle Initial Last Name Suffix Title Social Security Number Mailing Address City State Zip Code Daytime Phone Number Home Phone Number E-mail Address Please do NOT email me important news and updates.

Equipment Location Information

Is the equipment location different than the business street address? Yes No

Landlord First Name Landlord Last Name Equipment Location Address City State Zip Code Landlord Phone Number Landlord Fax Number E-mail Address

Banking History

Please provide at least two years of history.

Bank Reference

Name of Bank Primary Contact's First Name Contact Last Name Bank Address City State Zip Code Account Number Date Opened Phone Number Fax Number

Trade Reference Information

One or more references should be comparable in size to this request

Trade Reference Trade Reference Primary Contact's First Name Contact Last Name Reference Address City State Zip Code Account Number Date Opened Phone Number Fax Number

Financial Statement & Tax Return

eFinancial Bank requires both a Financial Statement (which can be submitted online) and your company's previous year's Tax Return in order to approve your Leasing Application. Please check the following:

How will your financial statement be delivered? Submitted Online Mailed Faxed Delivered to Bank

Financial Statement Delivery Date

How will your tax return be delivered? Mailed Faxed Delivered to Bank

Tax Return Delivery Date

Vendor Information

Vendor Name Primary Contact's First Name Contact Last Name Vendor Address City State Zip Code Phone Number Fax Number

Equipment Description & Information

Give a full and complete description of equipment. Please send actual quotations and copies of brochures when possible. Equipment Cost Before Tax Sales Tax Percentage Lease Term Desired

Has any factor or payment been quoted? Yes No

Endorsement

The undersigned on behalf of the business, and each individual listed hereof authorize eFinancial Bank to receive from, and give to, the undersigned on behalf of the business' or individual's accounts or credit experience; and the undersigned authorizes any party listed hereon, to release to eFinancial Bank, information about the business' or individual's accounts or credit experience. This shall be authorization for all present and future disclosures of account information and credit experience on the business and individuals listed hereon made by eFinancial Bank, or any party requested to release such information to eFinancial Bank.

I certify that all information provided by me herein, including attachment(s) is true, correct and complete. I authorize Bank Name to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date