Corporate Credit / Lease Information at Insight

Business Lease Credit Application
Application Information
Company Name:
Company Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Type of Business:
Years in Business:
Bank Reference
Bank Name:
Address:
Phone Number:
Transit Number:
Account Number:
Contact:
Details of Transaction
Equipment Description:
Hardware Cost:
Software Cost:
Other Cost:
Cost Lease Based On:
Term:	Monthly Quarterly
Principals/Shareholders Ination
Contact Name:
Title:
SIN Number:
Personal Address:
City:
Province:
Postal Code:
E-mail Address:
Phone Number:
Date of Birth:	/ /
% of Ownership:
Authorization
By submitting this application, I/We consent Insight Canada and its leasing agent to obtain from any credit reporting agency or credit grantor, such information as it may require at any time in relation to the credit hereby applied for, and consent to the disclosure at any time of any information concerning applicant submitting this form to any credit reporting agency or to any other credit grantor with whom the applicant has financial relations. By submitting this application warrants the truth and accuracy of the information provided.
Insight Canada and its leasing agent.