Simply ONE Solution Lease Application

Print out the following application. Fill out in ink, sign, and mail to POB 256 Atl. Beach, N.Y. 11509-0256. 
Vendor # Vendor Full Name Telephone #
Lessee Full Company Name Do not have anyone other than SOS contact me

 
Address City State Zip

Telephone Contact Person Title

 
Business Structure Amount $ Purchase Option Deferral # Days No. of Years in Business Equipment Cost
Proprietorship or Advance Rental or $1.00 or
Partnership or Security Deposit 10% or
Corporation FMV

  
Equipment Description Type of Business Payment Amount 
Lease Term		 Frequency
Monthly or Quarterly

    NOTICE: If your application for business credit is denied, you may have the right to a written statement ofthe specific reasons for the denial. TO OBTAIN THE STATEMENT, please contact the lessor named herein within 50 days from the date you are notified of our decision. We will send you a written statement of the 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 concerning this creditor is Federal Trade Commission , ECOA Compliance, Washington D.C. 20581.

Guarantor Information Requested for all corporations in business less than two years and all partnerships, proprietors,  professionals, and service related business.

 Personal Data

Name  Home Address Social Security Number Phone
Name Home Address Social Security Number Phone

 
REFERENCES: (LIST BANK OR BANKS PREVIOUS BANK REQUIRED IF APPLICANT HAS BEEN AT PRESENT LESS THAN TWO YEARS).
Present Bank of Applicant Previous or Second Bank of Applicant
Branch Phone Branch Phone
Branch Phone Branch Phone
Name Of Bank Officer Account Number Name Of Bank Officer Account Number
Loan/ Lease/ Trade References: Name: Address Phone Contact
1-
2-
3-

 
I AUTHORIZE THE RELEASE OF ANY CREDIT OR FINANCIAL INFORMATION TO SIMPLY ONE SOLUTION AND LESSOR. 
Authorized Signer and Title 
 

Acceptance of Equipment
CERTIFICATE OF ACKNOWLEDGMENT AND ACCEPTANCE OF  LEASED EQUIPMENT LEASE #
LESSEE HEREBY ACKNOWLEDGES RECEIPT OF ALL THE EQUIPMENT DESCRIBED IN ITS LEASE WITH LESSOR ("THE EQUIPMENT") AND ACCEPTS THE EQUIPMENT AFTER FULL INSPECTION THEREOF AS SATISFACTORY FOR ALL PURPOSES OF THE LEASE. LESSEE ACKNOWLEDGES THAT LESSOR HAS FULLY AND SATISFACTORILY PERFORMED ALL COVENANTS AND CONDITIONS TO BE PERFORMED BY LESSOR.
Date Of Delivery Lessee
Date Of Lease By:
(Signature) and Title
Print Name Of Signet and Date

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Thank you for applying and good luck!

Please contact Simply ONE Solution with any questions or for assistance at:

sos@simply-one-solution.com or worldwide voice/fax 1.516.371.5975

USA Toll Free 1-888-SOS-HERE