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Secure Lease Application

Please complete our simple one-page application below. Our site is completely secure and we maintain full privacy of your information.
If you prefer to print out an application and fax it back, download it by clicking here.

Required fields are marked with *

Primary Information
First Name:*
Last Name:*

Email Address:*

 

Company Information
Company Name:*
Company Address :*
City:*
State:*
Zip Code:*
Phone #:*
Fax:
Years In Business:*
Type Of Business:*

Principal Owner Information
Principal 1 Name:*
Social Security Number:*
Address:*
City:*
State:*
Zip Code:*
Ownership %:*
Principal 2 Name:
Social Security Number:
Address:
City:
State:
Zip Code:
Ownership %:
Bank References
Bank Name:*
Account #:
Bank Phone Number:

 

Equipment & Terms
Product:*
Retail Cost:*
Lease Term:
Vendor Company Name:*
Vendor Contact Name:
Vendor Phone Number:*
Vendor Email Address:

Add any additional information you think might be helpful or special instructions below.
How Did you hear about JB2 Funding?:

By my/our signature on this Application, I/we hereby certify that all information contained in this application & attachments are true and complete and are made for the purpose of obtaining credit. I/we authorize JB II Funding Corp, and/or its assigns, to verify any of the information above from whatever source it deems appropriate, which authorization shall extend to obtaining and review of my/our personal credit from a national credit bureau and subsequently for the purpose of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. I/we authorize any of the above references to release credit information to JB II Funding Corp. and/or its assigns. I/we also hereby authorize JB II Funding Corp to send our company correspondence via fax, email or any other electronic transmission as it deems necessary. I/We understand that by providing the fax number(s) and email address above, on behalf of the company specified above, I/ am authorized to and hereby consent for the Company to receive faxes sent by or on behalf of JB II Funding Corp and its affiliates. I acknowledge my rights under the F.C.R.A. It is understood that this Application shall remain the property of JB II Funding Corp. whether or not credit is granted and that this constitutes an application only and shall not be binding upon either JB II Funding Corp. or the applicant. By signature, I/we affirm my/our identity as the respective individual/s identified in the above Application. If this Application for business credit is denied, you have the right to a written statement of the specific reasons for denial. A facsimile of this application with signature shall be considered to be an original.