*About Vector Vacuums, Vector Vacuum Technologies, Financing

Performance Proven Vacuum Solutions™

Financing

Please contact Mr. Tony Lio at One Source Leasing & Financing details.

(973) 772-0094

Please print the application and submit directly to Tony for approval.

Startup & High Risk Companies Welcome!

ONE SOURCE LEASING & FINANCING

Your one source for equipment financing A through D credit.

50 MAITLAND PLACE, GARFIELD, N.J. 07026

PHONE: (973) 772-0094 ~ FAX: (973) 772-0097

onesourcelease@optonline.net

APPLICANT INFORMATION:	VENDOR INFORMATION:
COMPANY_________________________________________ DBA NAME _______________________________________ STREET ___________________________________________ CITY _______________________________ STATE _______ CONTACT __________________________ ZIP ___________ PHONE ___________________ FAX ___________________	VENDOR NAME ___________________________________ STREET __________________________________________ CITY _____________________________________________ STATE __________________ ZIP _____________________ PHONE __________________ FAX ____________________ SALES REP. _______________________________________
DATE ESTABLISHED _______________ FED TAX ID. #_________________________ (OR) S.S. #______-_____-_______ (please check one) � CORPORATION � PROPRIETORSHIP � PARTNERSHIP TYPE OF INDUSTRY OR SERVICE ________________________________________________________________________
EQUIPMENT INFORMATION:
EQUIPMENT DESCRIPTION ______________________________________________________________________________ Manufacturer/Year New or Used / Model / Serial # EQUIPMENT COST _________________ LOCAL TAX RATE ________ TERM ________ LEASE OPTION _____________ (Excluding Sales Tax)
TRADE REFERENCES: (CREDIT CARDS ARE NOT ACCEPTABLE AS TRADE REFERENCES)
COMPANY __________________________________ CONTACT __________________________ PHONE _______________ COMPANY __________________________________ CONTACT __________________________ PHONE _______________ COMPANY __________________________________ CONTACT __________________________ PHONE _______________ BANK REFERENCE: IF ACCOUNT IS UNDER 2 YEARS, PROVIDE PRIOR BANK INFO. CREDIT REF. LEASE OR LOAN BANK___________________________________________ CREDITOR__________________________________ ACCT.#____________________________________________ ACCT.#_____________________________________________ ACCT. OPENIING DATE_____________________________ ACCT. OPENING DATE_______________________________ CONTACT_________________________________________ CONTACT__________________________________________ PHONE____________________________________________ PHONE_____________________________________________ (B&C Credit, please provide 3 months bank statements).
OWNER (Stockholder Information): PLEASE INCLUDE HOME PHONE #_____________________________________
NAME _____________________________________________ NAME _____________________________________________ STREET ____________________________________________ STREET ___________________________________________ CITY________________________________ STATE ________ CITY _______________________________ STATE________ ZIP ______________ S.S. #____________________________ ZIP _______________ S.S. #___________________________ TITLE ______________________________________________ TITLE _____________________________________________
AUTHORIZATION TO RELEASE INFORMATION:
The undersigned authorizes and instructs any person, consumer reporting agency or bank institution to compile and furnish the lessor with any information it may have in response to any inquiry from the lessor. The undersigned further states that all of the above statements are true and complete and are made to the lease financing of equipment. APPLICANT�S SIGNATURE_______________________________ DATE________________