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<br />TOSHIBA BUSINESS SOLUTIONS <br />-A TOSHIBA COMPANY- <br /> <br />LEASE APPLICATION <br /> <br />LESSEE <br />Company <br /> <br />BIlling Address <br /> <br />, City <br />ConIact ~\erson <br /> <br />County <br /> <br />Slate <br /> <br />ZIp <br /> <br />Telephone No. <br />( ) <br /> <br />11IIe <br /> <br /> \ I <br />Nature of Business Type of ~ iless Ii No. of Years In BusIness <br /> o Non Pn: '" 0 Proprietorship 0 Partne 0 Corporation <br />DESCRIPTION OF EQUIPMENT: \ / <br /> \ / <br /> \ / <br />Ust Price $ <br /> " / <br />Lease Term: Rental $ , Advance Rental Amount $ <br />Location of Equipment: / <br /> '/ <br />PERSONAL INFORMATION ON OFFICERS, PARTNERS, OR GUARANTOR$' <br />Name // I Title Social Security No. <br />Home Address / City Slate ZIp I Home Phone No. <br /> ( ) <br />Name / I Title SocIal Security No. <br />Home Address / City Slate ZIp I Home Phone No. <br /> \ ( ) <br />BANK REFERENCES 1 / \ <br />Name of BankJBranch 7 Chkg. AccL , \ Telephone No. Contact OffIcer <br /> LOIIn AccL , ( ) <br />Name of BankJBranch /lSlale Chkg. AccL , Telephone No. Contact OffIcer <br /> Loan Acct. , ( ) <br />TRADE REFERENCES 1 / <br />Name of Supplier City /Slate Chkg. Acet. , Telephone No. Contact OffIcer <br /> LMn Acct. , ( ) <br />Name of Supplier CltylSlate Chk. AccL , \ TeI~ne No. Contact OffIcer <br /> LMn Acct. , ( ) <br />Vendor: , <br /> <br />Salesman: <br /> <br />Phone ,: <br /> <br />Date: <br /> <br />CUSTOMER'S AUTHORIZED SIGNATURE TO RELEASE INFORMATION: <br />