Lease Application      Print Out, Fill In & Fax Over
Note: Signature requirements preclude on-line application at this time. This protects you.

Phone (800) 532-7303    (800-LEASE-03)               FAX  (800) 653-2733

APPLICANT THE VENDOR
NAME ________________________________________ NAME ______________________________________
ADDRESS_____________________________________ ADDRESS___________________________________
CITY______________________ ST_____ ZIP________ CITY_____________________ ST_____ ZIP_______
PHONE_________________ FAX__________________ PHONE_________________ FAX________________
YEARS IN BUSINESS___________________________ SALES REP__________________________________
TYPE OF BUSINESS____________________________ DELIVERY DATE_____________________________
CONTACT __________________EIN #_____________ SHIP TO (IF DIFFERENT)______________________
PROPRIETORSHIP [ ]    PARTNERSHIP [ ]        CORPORATION [ ]       LLC [ ]           NON-PROFIT [ ]
THE PRINCIPALS   (It is prudent to be sure you wish to proceed before adding an inquiry to your credit report.)
By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to Lessor or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in the above application.
OFFICER RESIDENCE ADDRESS SOC. SECURITY #   Ownership
______________________________________ ___________________________________________ ____ ___ _____     ____ %
______________________________________ ___________________________________________ ____ ___ _____     ____ %
______________________________________ ___________________________________________ ____ ___ _____     ____ %
BANKING
BANK & BRANCH_____________________________ CONTACT NAME_____________________________
TELEPHONE__________________________________ ACCOUNT NUMBER(S)________________________
TRADE REFERENCES (NEED 3 RESPONSIVE REFERENCES)
TRADE REFERENCE CITY CONTACT OR A/C # TELEPHONE
____________________________________ _________ ___________________ _________________
____________________________________ _________ ___________________ _________________
____________________________________ _________ ___________________ _________________
FINANCIAL INFORMATION
FINANCIALS NEEDED OVER $100,000 AND OFTEN GAIN PREFERRED RATES ON SMALLER PACKAGES
STATEMENTS ATTACHED [ ]  WILL FORWARD [ ] NOT AVAILABLE [ ]
TAX RETURNS ATTACHED [ ] WILL FORWARD [ ] NOT AVAILABLE [ ]
THE EQUIPMENT THE LEASE
EQUIPMENT DESCRIPTION COST LEASE TERM BUY OPTION
_________________________________________ $___________ _____ MO $1.00 [ ]   FMV [ ]   10% Cmtmnt [ ]
AUTHORIZATION - Please sign this box
I hereby authorize release of all credit information to
KEYSTONE EQUIPMENT LEASING, INC. and its affiliates                 Signed____________________________________________

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NOTICE

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact the President of Keystone Equipment leasing, Inc. at the above address and telephone, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into a binding contract); or because all or part of the applicant's income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity , Washington, D.C. 20580.