Credit Application
Thank you for the opportunity to work with your company. Please fill in as much information as possible on the form below.

If you are more comfortable faxing your credit information, please click here for our one-page Credit Application. Just print the application, fill in the appropriate information, and fax to us at 315-410-5317.

All fields with (*) must be completed.

Business Information
Company Name *  
Contact Name *  
Telephone Number *
E-Mail *
Street Address *  
City *  
State *  
Zip Code *  
Number of Years in Business *  


Lease Transaction Information
Referred By   
Structure (FMV/$1BO/Other) *   FMV
$1BO
Other
Term (# of months) *  
Total Request Amount *  
Equipment Description *
(i.e. Manufacturer, Type of Equipment,
Installation, Maintenance,
Software, etc) 		 


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