Untitled Document

LESSEE
PHONE NUMBER
ADDRESS
Street
City
State
Zip
FEIN #
BILLING NAME
PHONE NUMBER
BILLING ADDRESS (If different)
Street
City
State
Zip
PRINCIPAL'S NAME
SSN
HOME ADDRESS
Street
City
State
Zip
NAME & TITLE OF OFFICER SIGNING LEASE

EQUIPMENT
Description
Invoice/Cost($)
Payment Amount($)
Sec. Dep.
Monthly Payment
Tax Payment($)
Purchase Option
Term
Total Payment($)

BANK
Name
Account #(s)
Phone #
Contact
City/State
Type of Account(s)
TRADE REFERENCES
Name
Name
Name
City/State
City/State
City/State
Phone #
Phone #
Phone #
Contact
Contact
Contact

INFORMATION RELEASE
Bank/Creditor
Attention
ADDRESS
Street
City
State
Zip
Customer Name
Account Number(s)
COMVEST Ltd., Inc. , will be requesting information by telephone on all accounts maintained with you. Please accept this release as authorization to provide the requested information.
*This field is required* I agree with the terms of the Statement I disagree with the terms of the Statement
Date (MM/DD/YYYY)