Equipment Lease Agreement No



CUSTOMER APPLICATION FORM

Please complete all credit information in detail. A complete form provides information that will help us better respond to your equipment needs.

If you have a question about how to complete this online application form, please contact our Customer Service Center at 1-970-518-9079. Thank you.

Copies of your most recent year-end financial statements are required for all lease arrangements of 12 months or longer and for self-insurance requests. Financial statements are held in strictest confidence and will be forwarded to an All Ways Leasing, LLC regional credit manager for review.

If your lease/rental transactions are tax exempt, you must return a completed tax exemption certificate for each state in which your company wants to establish an account.

Thank you for your interest in doing business with All Ways Leasing, LLC. We look forward to serving you.

CUSTOMER INFORMATION:

Company Legal Name ______________________________________________

Street Address: _________________________________________________ City, State and Zip Code: ____________________________________________

Phone:______________________________________________________ Fax #: ___________________________________________________________

Email: ______________________________________________________ Web Site: ________________________________________________________

President/CEO: _______________________________________________ Officer (Name & Title): ____________________________________________

BUSINESS TYPE:

(Select the type that best describes your business)______Sole Proprietorship _______Corporation _______Partnership

Fed ID or Tax ID Number: ___________________________________

GENERAL BUSINESS INFORMATION:

Date Operation Began (mm/dd/yyyy):_________________________________

Number of Employees: __________________

Type of Business: ____________________________________________________

Are purchase orders required to do business with your company? YES ___________ NO ____________

CUSTOMER APPLICATION FORM (CONT.)

TAX STATUS:

Is your business tax exempt? YES ___________ NO ____________

If claiming tax exempt, you must provide a Tax Exemption Certificate acceptable to All Ways Leasing, LLC

HAZARDOUS MATERIAL

Are you a transporter of hazardous material, refuse or waste hauler as regulated by Motor Carrier Act 1980? YES ___________ NO ____________

If yes, and MC-990 endorsement must be on your auto liability policy.

Specify the type of material, refuse or waste your company hauls:______________________________________

INSURANCE REQUIREMENTS

Liability Insurance: All Ways Leasing, LLC must be listed as additional insured and loss payee. Minimum liability coverage required.

Commercial General Liability - $1 Million Auto Liability - $1 Million

Please provide the following information:

Insurance Agency/Carrier name:_______________________________________________

Contact Name: _________________________________________________ Phone Number: (Please include area code): _____________________________

Physical Damage

Option A

All Damage Waiver (ADW)/Fire Theft Waiver (FTW)

All Ways Leasing, LLC will provide a price quote based on my company's equipment requirements.

Option B

Customer Provided Insurance (Please provide the following Information:)

Insurance Agency/Carrier name:_______________________________________________

Contact Name: ________________________________________________ Phone Number: (Please include area code): ______________________________

REFERENCE INFORMATION

Bank and Trade references (Please list equipment references - rent, lease or finance.)

CUSTOMER APPLICATION FORM (CONT.)

A copy of your most recent year-end financial statement is appreciated. Financial statements are required for all lease agreements of 12 months or longer and for self-insurance requests.

Please check your information to make sure it is correct before you submit. Thank you.

By signing below, (1) I represent and warrant that I am authorized to agree to the Standard Terms and Conditions on behalf of the applicant, (2) I am the individual identified above, (3) I understand that I am personally guaranteeing payment of all lease agreements entered into by and on behalf of the company for which this application is submitted, and (4) I understand that I am agreeing to the Standard Terms and Conditions on behalf of the applicant. A copy of the Standard Terms and Conditions may be found on our company web site at .

Date: _________________________

By: ____________________________________________

Print: ___________________________________________

Title:___________________________________________

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If a Sole Proprietorship, please fill out the following information:

First Name: ________________________________

Middle Name: ______________________________

Last Name: ________________________________

The name shown under Sole Proprietorship must be the same individual who approved the Standard Terms and Conditions.

By selecting Sole Proprietorship, you authorize All Ways Leasing, LLC to conduct a personal credit check to verify the information on this application.

Social Security Number:_____________________

Date Of Birth (MM/DD/YY): ________________

BILLING ADDRESS if different from Street Address: May we bill you via email? ______Yes ________No

Billing Address: ___________________________________________City, State and Zip Code: __________________________________________

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Secured Yard Location:

9701 E. 102ND AVENUE

HENDERSON, CO 80640

(303) 219-4396

Billing:

P.O. Box 200383

Evans, CO 80620

(303) 219-4396

FAX (360) 935-8573

Bank Name: ___________________________________________________

Street Address: ____________________________________________________

City, State and Zip Code: ____________________________________________

Account #: ________________________________________________________

Contact: __________________________________________________________

Phone (Include Area Code): ___________________________________________

Brief Description of Reference:________________________________________________________________

_________________________________________________________________________________________

Trade Reference Name: _____________________________________________

Street Address: ____________________________________________________

City, State and Zip Code: ____________________________________________

Account #: ________________________________________________________

Contact: __________________________________________________________

Phone (Include Area Code): ___________________________________________

Brief Description of Reference:________________________________________________________________

_________________________________________________________________________________________

Trade Reference Name: _____________________________________________

Street Address: ____________________________________________________

City, State and Zip Code: ____________________________________________

Account #: ________________________________________________________

Contact: __________________________________________________________

Phone (Include Area Code): ___________________________________________

Brief Description of Reference:________________________________________________________________

_________________________________________________________________________________________

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