Lease Application

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LEASE APPLICATION Call 800-780-4770 ext. 121 Fax 813-960-5000 Attn: Steve Carnes
Customer
Information		 Company Name OR Individual Last, First and Middle Name, Suffix DBA
Company Address City State Zip County
Contact Name Business Telephone # Business Fax #
Business
Type
Sole Proprietorship
S Corporation		 Limited Liability Company
General Partnership		 Limited Partnership
C Corporation
State of Incorporation Date Established Yrs in Business (Present Ownership) Nature of Business
Equipment
and Vendor
Information
(Attach separate
sheet if necessary)		 Qty Manufacturer/Model/Description/Serial Number Delivery Date Equipment Cost Total Cost
1. Vendor Name
ROTOVAC CORPORATION		 Contact Name
CHUCK MONSON		 Contact Telephone #
425-883-6746		 Fax #
425-883-8953
Vendor Address, City, State, and Zip
18392 Redmond Way, Redmond, WA 98052		 E-mail Address
chuckm@rotovac.com
Qty Manufacturer/Model/Description/Serial Number Delivery Date Equipment Cost Total Cost
2. Vendor Name Contact Name Contact Telephone # Fax #
Vendor Address, City, State, and Zip E-mail Address
Payment
Plan		 Lease Term (months)
24 36 48 60		 Lease Structure
FMV 10% PUT $1 OUT
Bank
References

2 Year History

 1. Bank Name City State Contact Name
Lease/Loan Acct. # Lease/Loan Original Date Lease/Loan Original Term (months)
Checking Acct # Telephone # Fax #
2. Bank Name City State Contact Name
Lease/Loan Acct. # Lease/Loan Original Date Lease/Loan Original Term (months)
Checking Acct # Telephone # Fax #
Owners,
Partners and
Guarantors
(Attach separate
sheet if necessary)		 1. Name Title % Ownership Owner Since
Home Address City, State, Zip
Home Telephone # Fax # E-mail Social Security # Date of Birth
2. Name Title % Ownership Owner Since
Home Address City, State, Zip
Home Telephone # Fax # E-mail Social Security # Date of Birth
3. Name Title % Ownership Owner Since
Home Address City, State, Zip
Home Telephone # Fax # E-mail Social Security # Date of Birth
By submitting this Application, you grant consent to and authorize ERVIN Leasing and its agents to obtain commercial and consumer



credit reports and make other credit inquiries that it determines necessary, and you represent that each individual listed on this



Application as a principal, partner, owner, guarantor or obligor likewise has authorized Ervin to obtain consumer credit reports and



make other credit inquiries that it deems necessary on them. You also warrant the information on or accompanying this Application is



true and complete, and you agree to notify ERVIN of any material change in any such information. You authorize ERVIN and any credit



bureau or investigative agency to investigate the references, statments and other data on or accompanying this Application, and you



authorize anybody contacted to release credit and financial information requested as part of said investigation. Finally, you confirm



that this Application is submitted in Connection with financing solely for business and commercial purposes and NOT for personal, family



or household purposes.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the finding of terrorism and money laundering activities Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

EQUAL CREDIT OPPORTUNITY ACT. 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 our Customer Service Representative, 11100 Wayzata Blvd., Suite 801, Minnetonka, MN 55305 (800-681-7474) 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 race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); 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 Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3710, Houston, Texas 77010.

Signature X ____________________________ Print Name _____________________________ Date ___________________
PLEASE RETAIN A COPY OF THIS APPLICATION AND NOTICE ERVIN app Broker, Rev 10/03