A Printable Application is also available in PDF format.
3187 Airway Ave
Costa Mesa, CA 92626
Tel: 877-727-4327
Fax: 877-337-3227
www.EndeavorFS.net
  LESSEE Date: SALESREP:
Business Legal Name (DBA)
 Phone #:
Fax #:
Billing Address
City
County
State
Zip
Website:
 E-mail Address:
Equipment Location (if other than billing)
Nature of Business Type of Org
Corp Sole Prop LLC Prtnr.		 Years in Business
(Under Current Ownership)
Contact Name Title
# of Employees
Fed Tax ID #
  PERSONAL INFORMATION
Name
Title
% Ownership
 SSN
Home Address
Mobile Phone
Home Phone
Name
 Title
 % Ownership
 SSN
Home Address
Mobile Phone
Home Phone
  BANK / LOAN REFERENCES
Bank Account Number Telephone Number Fax Number Contact Person
  TRADE REFERENCES
Company Name Account Number Telephone Number Fax Number Contact Person
  VENDOR INFORMATION
Vendor Name
Contact
Telephone Number
Address
 City
 State/Zip
Fax Number
Vendor Website
Vendor E-mail Address
 
  EQUIPMENT TO BE LEASED
Description (Include Make, Model, Serial #): Equipment Cost:
New Used

$
  NOTES:
  ACKNOWLEDGEMENT AND AUTHORIZATION

By selecting the checkbox below, the undersigned individual as principal of and/or guarantor for the applicant, authorizes Endeavor Financial Services, it’s designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this Application and for the purpose of the update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. By signing below the applicant certifies that all credit and financial information submitted is true and correct and also authorizes all Bank and/or Trade References provided by the applicant to disclose information and investigation results to each other. A fax or photocopy of this authorization shall be valid as the original.
Signature of Applicant (Check) Date