Company Information
Fields in red MUST be completed
Company Legal Name Trade Name
Address City Province Postal Code
Contact Name Title Telephone Fax
Industry Years In Business Type of Business
Landlord Name Contact Telephone Fax
Bank Name Branch Contact Account Number
Address City Telephone Fax
Lease Details
Vendor (If Unknow put TBA) Contact Telephone Fax
Equipment Description Term Equipment Cost ( Pre Tax )
Months $
BY CLICKING THE 'Submit' BUTTON, I CERTIFY THE ABOVE INFORMATION TO BE TRUE AND CORRECT. BY CLICKING THE 'Submit' BUTTON, I CONSENT AND AUTHORIZE EQUIREX LEASING CORP. AND ITS REPRESENTATIVES, AT ANY TIME TO OBTAIN, VERIFY, USE, COMMUNICATE WITH AND DISCLOSE TO THIRD PARTIES (INCLUDING CREDIT REPORTING AGENCIES, CREDIT EXCHANGES, LEASING BROKERS AND CREDIT GRANTORS) ANY OF MY CREDIT, ANCILLARY DEED OR TRANSACTION,, INCLUDING BUT NOT LIMITED TO ASSIGNMENTS AND SECURITIZATIONS.

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Equirex Leasing Corp - 700 Dorval Drive - Suite 302, Oakville, Ontario - L6K 3V3
Phone: 1-877-378-4739 - (905) 844-4424 Fax: 1-866-404-4148 Email: leasing@equirex.com