Online Credit Application

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All of the information provided below will be kept confidential. Fields listed in red are mandatory.

Lessee (Full Legal Name):

Phone:

Date of Birth:

SS#:

Street Address:

City:

State:

Zip Code:

Years in Business:

Type of Business:

Business Type:

Proprietor Partnership Corporation

1. Officer Name:

Title:

Address:

SS#:

2. Officer Name:

Title:

Address:

SS#:

Equipment:

Location if different
from above:

Price:

Lease term in Months:

Payment Amount:

Adv. Rentals:

Banks: Please show at least two years of banking history with officer's name.

1. Name:

Acct#:

Contact:

Phone:

2. Name:

Acct#:

Contact:

Phone:

Trade References:

1. Name:

Acct#:

Contact:

Phone:

2. Name:

Acct#:

Contact:

Phone:

3. Name:

Acct#:

Contact:

Phone:

By signing below, each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Granite Leasing Company or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit application and subsequently for the purposes of update, renewal or extension of such credit and for reviewing or collecting the resulting account. TYPING YOUR NAME IS LEGALLY THE SAME AS YOUR SIGNATURE.

Signature:

Date:

Signature:

Date:

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, D.C. 20S80. If your application for business credit is denied, you have the right to a written statement of the specific reasons for denial. To obtain the statement, please contact lesscr set forth above within 60 days (ram the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Additional Comments

* Enter the code below:

I agree to the following terms:

By submitting this application I authorize Riley Built Inc. and other lending institutions that do business with Riley Built Inc. permission to review the applicants credit history for the purpose of accepting or rejecting the above applicant for the lease purchase of any Riley Built equipment. Riley Built Inc. reserves the right to accept or reject any applicant.

Online Credit Application

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