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PLI LEASE APPLICATION

Company Name	Your Name
Address	City
County	State
Zip Code	Telephone No.
Fed ID No.
Equipment to Be Leased Email separate list if necessary to info@plileasing.com.	Type New Used
Name and Address of Insurance Agent	Insurance Contact
Insurance Phone No.
Nature of Your Business	No. of Yrs in Business
APPLICANT SS No.	SPOUSE SS No.
Type Organization Organization Corporation Partnership Proprietorship LLC	Home Address
Bank Name	Bank Address
Bank Contact	Bank Phone
2d Bank Name	2d Bank Address
2d Bank Contact	2d Bank Phone
Term/Trade Creditor	Term/Trade Address
Term/Trade Contact	Term/Trade Phone
Term/Trade Creditor 2	Term/Trade Address 2
Term/Trade Contact 2	Term/Trade Phone 2
Certification I hereby certify that the information contained in this application is true and accurate to the best of my knowledge, and I hereby authorize our banks, trade references, and financial institutions the right to release credit information.	Applicant Name for Certification
Date
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