LESSEE (applicant's full legal name. Registered corporate name.)
*Company	DBA
*FED. TAX I. D. NO. (or SS# if SOLE PROP.)	TAX EXEMPT? No    Yes (Provide a copy of certificate.)
*ADDRESS
*CITY	*STATE                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

---

COMPANY CONTACT
*FIRST NAME	*LAST NAME
TITLE	*EMAIL
*PHONE	FAX

---

STRUCTURE OF ORGANIZATION: Proprietorship L.L.C. L.L.P. C. Corp. S. Corp Partnership, General Partnership, LTD Ptsp. Non-profit	STATE OF ORGANIZATION                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
TYPE OF BUSINESS	YRS. IN BUSINESS
YRS. UNDER PRESENT CONTROL	D. & B. NO.

---

LEASE SELECTION

Term 24 months 36 months Other Type FMV $1.00 Buyout New Business

---

EQUIPMENT PURCHASE

Estimated Equipment Cost/Requested Credit $ (Click here to estimate monthly lease payments.)

---

PERSONAL INFORMATION ON PRINCIPALS, OFFICERS, PARTNERS, GUARANTORS
OFFICER'S FIRST NAME	OFFICER'S LAST NAME	SOCIAL SECURITY NO.
HOME PHONE	% OWNERSHIP	TITLE
ADDRESS
CITY	STATE                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP

---

COMPANY BANK REFERENCES - MUST HAVE 2-YEAR HISTORY
NAME OF BANK/BRANCH	PHONE	HOW LONG?	ACCT. #
CONTACT OFFICER			LOAN #
PREVIOUS BANK	PHONE	HOW LONG?	ACCT. #
CONTACT OFFICER			LOAN #

---

TRADE REFERENCES AND OTHER LEASES
NAME OF SUPPLIER	PHONE	ACCOUNT #
ADDRESS		CONTACT PERSON
CITY	STATE                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP
NAME OF SUPPLIER	PHONE	ACCOUNT #
ADDRESS		CONTACT PERSON
CITY	STATE                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP
NAME OF SUPPLIER	PHONE	ACCOUNT #
ADDRESS		CONTACT PERSON
CITY	STATE                   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP

AUTHORIZATION AND ACKNOWLEDGEMENT We hereby authorize fwitsolutions.com to investigate my/our financial worthiness and will provide financial statements, tax returns, etc. as you deem necessary. We agree that any Advance Deposit is not refundable unless application is rejected by Lesser.