Retail Application – Banclease Acceptance Corporation

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Please complete the application below. One of our Leasing professionals will respond in a timely manner.

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Applicant Information
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
SS#*
Phone
Email*
Address*
Street Address City State ZIP Code
How Long have you lived at your above address?*
- Less than 2 years
- 2+ years
Previous Address*
Street Address Address Line 2 City State ZIP Code

Employer Information
Employer*
Position*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Income Interval*
- Hourly
- Salary
Annual Income*
How long have you worked for your previous employer?*
- 2+ years
- Less than 2 years
Previous Employer Name*
Previous Employer Annual Income*
Previous Company Address*
Street Address Address Line 2 City State ZIP Code

Co-applicant Information (If Applicable)
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
SS#
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer
Position
Annual Income
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ECOA NOTICE AND DISCLOSURE. If your application for business credit is denied by BancLease Acceptance Corp.(“BancLease”), you have the right to a written statement of the specific reasons for the denial. You may obtain the statement by written request to 8221 Tristar Dr., Irving, TX 75063, phone 214-615-0667, within 60 days from the date you are notified of BancLease’s decision. BancLease will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. 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 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 has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

I/We the undersigned individual as principal of and/or guarantor for the applicant, authorizes BancLease Acceptance Corp., its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this Application and for the purpose

of update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. I/We authorize our bank to furnish any information requested. A fax copy of this authorization shall be valid as the original.

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