Leasing Plan *

Vendor Information

Customer Name *

Company Name *

Email *

Phone *

Address *

City *

State *

Zip Code *

Federal Tax ID (EIN) *

Business Information

Business Structure *

Years In Business *

Contact Person *

The Customer has authorized a Credit Investigation Credit Authorization Agreement

Ultimate Beneficial Ownership

Who are the Ultimate Beneficial Owners (UBOs) for the customer on this Credit Application?

When you provide UBO information, you enable us to comply with Anti Money Laundering regulations. Please provide any UBO information received from your customer.

Review the three UBO types below and select the UBO type for this credit application:

Ownership UBO: An individual, if any, who owns, directly or indirectly, more than 25 percent of the equity interests or Profit Sharing/Economic interest of the legal entity customer (e.g., each natural person that owns more than 25 percent of the shares of a corporation).

Effective Control UBO: If ultimate beneficial owner cannot be determined based on ownership, please provide the information for the natural person with effective control (day-to-day decision-making).

Board of Directors UBO: If neither of the above apply, please provide the information for all Board of Directors (BODs), Executive Management Team.

Ultimate Beneficial Owner Information

First Name *

Last Name *

Title *

Date of Birth *

Country of Residence *

Ownership Percentage *

Add Additional Ultimate Beneficial Owner information

Additional Ultimate Beneficial Owner Information

First Name *

Last Name *

Title *

Date of Birth *

Country of Residence *

Ownership Percentage *

I am requesting Tax Exempt Municipal Lease Financing based on an indication from the customer that they qualify for this program. *

I agree Terms and Conditions *

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Have a great day!

Lease Application

Vendor Information

Business Information

Ultimate Beneficial Owner Information

Additional Ultimate Beneficial Owner Information

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