Machinery Funding Division

Questions? Call 702.400.3460

Confidential Online Leasing Application

Once you submit the application you will be contacted by phone to confirm it prior to processing.

Company Information
Legal Business Name
Contact Name* (Required)
Business Address
City
State
Zip Code
Main Phone Number* (Required)    EXT:
Second Contact Number   EXT: 
Fax Number
Email Address
Tax ID Number
Years in Business
Type of Business Proprietorship     Partnership    Non Profit     Corporation     LLC
Banking Information
Bank
Phone
Contact
Account Number
Type of Account Checking    Savings 
Second Bank or Account
Bank
Phone
Contact
Account Number
Type of Account Checking    Savings 
Trade Reference #1
Company Name
Phone
Contact
Account Number
Trade Reference #2
Company Name
Phone
Contact
Account Number
Trade Reference #3
Company Name
Phone
Contact
Account Number
Signor 1
Signors Name
Title
Percentage of Ownership
HOME Address
City
State
Zip
Home Phone
Social Security Number
Signor 2
Signors Name
Title
Percentage of Ownership
HOME Address
City
State
Zip
Home Phone
Social Security Number
Equipment
The Equipment is NEW USED
Equipment Description
Please Include

Manufacturer, Model Number, Year, Options
Vendor Name
Contact Name
Phone Number
Funds Required
Amount of Loan Request Approx. 
Term Requested 2 YR.             3 YR.             4 YR.         5 YR. 
Comments
  This Box must be checked after reading the information below

By Checking this box, the online applicant / individual, who is either a principal of the credit applicant or a personal guarantor of obligations, provides written instruction to Fidelity Leasing, 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 Checking the Box, I/we affirm my/our identity as the respective individual/s identified in the above application.

Thank You for Completing the Online Application. We Look Forward to Serving Your Needs.