Above and Beyond is Our Norm

Secure Online Application

Please fill out the application below and click submit.
Click here to print an application that you can fax to us!
* indicates required fields
Customer Contact
* First Name * Last Name * Email Address
* * *
*Equipment you wish to lease * Quote Amount
* *

Business Information
* Legal Business Name doing business as
*
* Phone Number Fax Number Website
*
* Address * City * State * Zip Code
* * * *
Business Credit Information
FEIN (Employers Tax ID Number) D-U-N-S Number® (Dun & Bradstreet)
* Business Structure * Number of Employees
* *

Banking Reference (Primary Account)
* Bank Name * Account Number * Type of Account
* *
Officer/Contact Name Phone Number Fax Number

Credit Reference (Lease or Loan)
Creditor Contact Name Phone Number

Trade References
Supplier Company Name Contact Name Phone Number
Supplier Company Name Contact Name Phone Number
Owner/Stockholder Credit Information

Primary Owner/Majority Stockholder
* Owner's First Name * Owner's Last Name * Title * % Owner
Address City State Zip Code Soc Security #

Additional Owner/Stockholder
* Owner's First Name * Owner's Last Name * Title * % Owner
Address City State Zip Code Soc Security #

By filling in the field below with my full and proper name, and clicking "Apply", I/We as principal(s) of and/or guarantor(s) for the applicant(s), hereby consent to Caladesi Capital, Inc., its assigns or potential assigns, to obtain, use, review, and consider the personal credit profile provided by national credit bureaus in considering this Application for the purpose of extension of business credit to the applicant, or the renewal, or the collection, or updating of any resultant accounts. I/We authorize the banking and credit contacts listed above to release any and all credit and financial information requested. I/We expressly waive the rights of any direct, indirect, incidental, consequential or punitive damages arising out of the submission or use of our lease application. By clicking submit below the undersigned individual(s) hereby (1) affirm their respective identity as the individual(s) identified herein and (2) that their signatures below are their true and accurate signatures. A fax or photocopy of this authorization shall be valid as the original. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that is responsible for and administers compliance with this law concerning this creditor is, Equal Credit Opportunity, Federal Trade Commission, Washington, DC 20580.

Credit Authorization (Please fill in your full name)


© Caladesi Capital, Incorporated 2007
800-255-5341 - Florida & New Jersey