easy qualify lease application for predictive dialer

Lease Application
A PROGRAM ADMINISTERED BY
NOREAST CAPITAL CORPORATION
FAX APPLICATIONS TO 410-268-7269
For Questions Please call 800-268-5588

LESSEE/BUSINESS INFORMATION

LESSEE FULL COMPANY NAME		DATE ESTABLISHED UNDER CURRENT OWNERSHIP

D.B.A.		TELEPHONE NO.					FAX NO.

LESSEE FULL COMPANY ADDRESS		FEDERAL TAX ID NO.

CITY:			STATE:			ZIP:

INDUSTRY	PROPRIETORSHIP			PARTNERSHIP	CORPORATION			STATE OF INC.

GUARANTORS OWNERS	(1)	(2)	(3)
NAME
ADDRESS
HOME PHONE
SOCIAL SECURITY #
TITLE / % OWNERSHIP

CREDIT REFERENCES

BANK/CONTACT	CITY/STATE	PHONE NUMBER	ACCOUNT TYPE	ACCOUNT NUMBER
		Phone:
		Fax:
		Phone:
		Fax:
MAJOR TRADE	CITY/STATE	PHONE NUMBER	CONTACT	ACCOUNT NUMBER
		Phone:
		Fax:
		Phone:
		Fax:
		Phone:
		Fax:
LEASE/FINANCE	CITY/STATE	PHONE NUMBER	CONTACT	ACCOUNT NUMBER

DISTRIBUTOR INFORMATION

DISTRIBUTOR NAME			PHONE NO.			CONTACT
Chase Data Corporation			888-739-8218			Ahmed Macklai
ADDRESS				EQUIPMENT LOCATION IF DIFFERENT THAN LESSEE ADDRESS ABOVE
7811 West Commercial Blvd. FT. Lauderdale FL 33351
EQUIPMENT DESCRIPTION							NEW	USED

TERM	PURCHASE OPTION	DISTRIBUTOR REQUIRE DEPOSIT?			TOTAL INVOICE W/O TAX
	YES NO	YES NO IF YES HOW MUCH

CREDIT RELEASE AGREEMENT

The undersigned individual who is either a principal, a personal guarantor or a sole proprietorship of the credit applicant, recognizing that his or her Individual credit history may be a factor in the evaluation of the credit of the applicant, hereby consents to and authorizes the above named business credit provider and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent.

I STATE THAT THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND I HEREBY AUTHORIZE NETWORK FUNDING LTD. OR ASSIGNS, OR ANY OTHER CREDIT BUREAU OR INVESTIGATIVE AGENCY EMPLOYED BY SUCH PERSON TO INVESTIGATE THE REFERENCES HEREIN LISTED OR STATEMENTS OR OTHER DATA OBTAINED FROM ME OR ANY OTHER PERSON PERTAINING TO MY CREDIT AND FINANCIAL RESPONSIBILITY OR THAT OF THE OFFICERS, SHAREHOLDERS, OR OWNERS INDICATED ABOVE. CHECK HERE TO ACKNOWLEDGE LEASE TERMS

*E-MAIL ADDRESS

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contact information: ChaseData Corporation - 7811 Commercial Blvd.. Ft Lauderdale - FL - 33322
1 (888) 739-8218 toll free - 1 (954) 370-8465 fax

© 2000, 2001 ChaseData Corporation all rights reserved. Æ PowerStation and PowerStation Predictive Dialing Systems are registered Trademarks of ChaseData Corporation all other copyrights are the property of their respective owners.