Application Form - LeaseLine

Please ensure all required fields are completed.
Fields marked in Orange with a * are required.

Business

Business Type:

Proprietorship
Partnership
Corporation

Business Name:

Time In Business:

Business Description:

Address:

City:

Province:

Postal Code:

Contact Person:

Phone:

Email:

Fax:

Principal

Full Legal Name:*

Married:

Yes
No

Date of Birth*

YEAR

MON

DAY

SIN Number:

Phone:*

Home Address:*

City:*

Province:*

Postal Code:

Time at Address (Years):

Ownership Details:

Own Home
Rent Home

Monthly Rent (If Rented):

Mortgage Payment (If Own):

Mortgage Balance (If Own):

Value of Home (If Own):

LeaseLine Contact:

Vendor and Equipment

Dealer Name:

Phone:

Fax:

Contact Person:

Email:

Equipment Description:

Down Payment Available:

Term Requested:

Equipment Cost:

Equipment Status:

New
Used

How Did You Find LeaseLine?

Additional Comments:

Confirm Age:*

I confirm that I am 19 years of age or older.

Newsletter Sign Up

I would like to sign up for the Newsletter.

By proceeding with this online application, you agree with Leaseline’s Privacy Policy, and you will be deemed to have provided your written Authorization and Consent to Leaseline’s use and disclose of your business and personal information in accordance with our Standard Application Form as follows.

Leaseline is a trade name of Leaseline Financial Services Corp (herein “Leaseline”). The undersigned certifies to Leaseline that the above information is true and correct. Moreover, the undersigned authorizes and consents to Leaseline’s collection and use of any such information as may be required at any time in connection with this credit application from any credit reporting agency or credit grantor and to the disclosure of any information concerning the undersigned to any credit reporting agency or any credit grantor. In particular, the undersigned authorizes LeaseLine and/or LeaseLine's financial affiliates to request a copy of the undersigned’s credit report and to share the information on such credit report with one or more financial institutions. The undersigned further authorizes and consents to the collection, use, and disclosure of personal information by Leaseline or its representatives and the persons referred to in the related lease, finance, or rental agreement for the above purposes and the purposes described in the related lease, finance, or rental agreement. If undersigned’s application is approved, then the undersigned authorizes Leaseline to utilize the information referenced herein to administer the undersigned’s contract, determine insurance eligibility, and secure the assets being financed, or as required or permitted by law. The undersigned further authorizes Leaseline to use the information referenced herein for internal statistical analysis purposes and for Leaseline to retain an internal file containing some or all of the undersigned’s personal information for future reference or a future credit application.

Agreement:*

I have read the terms & conditions above and agree.

Commercial Credit Application

Business

Principal

Vendor and Equipment