Make Model New/Used Cost
Attachment(s) Descriptions Cost
Trade-in(s) Description
USAGE / APPLICATION
■
Rental Fleet
■
Normal/Clean
■
Freezer/Cooler
■
Foundry
■
Hazardous Waste
■
Recycling Metal/Paper
■
Moderately Abusive
■
Paper/Textile Mill
■
Corrosive
■
Other (Describe)
Hours Operated Annually
Number of Advanced Payments Finance Term Purchase Option
■
FMV
■
$1
■
FPPO
■
Loan
SALE PRICE
ATTACHMENTS
ATTACHMENTS
NET TRADE-IN ()
DOWN PAYMENT ()
TOTAL AMOUNT
TO FINANCE
You, the “Applicant” (which term includes the business entity as well as the undersigned individuals(s)), certify to us that Applicant is applying for credit for business reasons, and not for personal, fam-
ily or household purposes. De Lage Landen Financial Services, Inc. and/or its assigns (“DLL”), or its designees, is authorized to obtain information from others concerning Applicant's credit and trade
standing and other relevant information impacting this Application and provide to others information about its transaction and experiences with Applicant. DLL may obtain credit reports, including con-
sumer credit reports, in connection with the Application and, at Applicant's request, will tell Applicant whether a credit report was obtained and, if so, the name and address of the reporting agency which
provided it. Provided credit is granted, DLL may, without further notice to Applicant, use or request subsequent credit bureau reports (1) to update DLL’s information, (2) in connection with a renewal or
extension, and/or (3) in connection with Applicant’s request for additional services. Applicant agrees that DLL may get or share credit information with its agents, assignees, and its designees, regard-
ing the Applicant, Undersigned Individuals or Applicant’s owners in considering the Applicant's Application. Except as otherwise prohibited by law, Applicant agrees and consents that DLL may share
with affiliates and others all information about Applicant that DLL has or may obtain for, among other things, the purpose of evaluating credit applications or offering Applicant products or services that
DLL believes may be of interest to Applicant. Applicant represents that it has reviewed this document and the information herein is true, correct and complete. If Applicant is approved for credit, Applicant
authorizes DLL to file financing statements regarding the transaction.
THE APPLICANT HAS A RIGHT TO A STATEMENT OF THE SPECIFIC REASONS IF AN ADVERSE ACTION HAS BEEN TAKEN. TO REQUEST THIS INFORMATION, CONTACT OUR COMPLIANCE DEPART-
MENT WITHIN SIXTY (60) DAYS OF RECEIPT OF AN ADVERSE ACTION NOTIFICATION. THE DEPARTMENT CAN BE REACHED BY WRITING TO 1111 OLD EAGLE SCHOOL ROAD, WAYNE, PA 19087.
WHEN CONTACTING THE DEPARTMENT, PLEASE BE SURE TO REFERENCE THE APPLICATION NUMBER ON THE NOTIFICATION LETTER. DLL WILL PROVIDE APPLICANT WITH A STATEMENT OF
THE SPECIFIC REASONS FOR THE ADVERSE ACTION WITHIN THIRTY (30) DAYS AFTER DLL HAS RECEIVED APPLICANT’S REQUEST.
NOTICE: THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICANTS ON THE BASIS OF RACE, COLOR, RELIGION, NATION-
AL 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 AGEN-
CIES THAT ADMINISTER COMPLIANCE WITH THIS LAW CONCERNING THE DLL ARE THE BUREAU OF CONSUMER FINANCIAL PROTECTION, 1700 G STREET NW., WASHINGTON D.C. 20006 AND
THE FEDERAL TRADE COMMISSION, EQUAL CREDIT OPPORTUNITY, WASHINGTON D.C. 20580.
APPLICANT HEREBY AUTHORIZES DLL OR ANY CREDIT BUREAU OR OTHER INVESTIGATIVE AGENCY EMPLOYED BY DLL TO INVESTIGATE THE REFERENCES HEREIN LISTED OR STATEMENTS
OR OTHER DATA OBTAINED FROM APPLICANT OR FROM ANY OTHER PERSON PERTAINING TO APPLICANT’S CREDIT AND FINANCIAL RESPONSIBILITY.
X TITLE DATE
(SIGNATURE OF APPLICANT’S REPRESENTATIVE)
X DATE
(SIGNATURE OF PRINCIPAL)
CREDIT APPLICATION
E-mail credit application to: TSSapplications@leasedirect.com
FAX: 866-287-1176
05MHDOC043v6
©2016 All Rights Reserved. Printed in the U.S.A. 05MHDOC043v6 11/16
Applicant Company Name TYPE OF BUSINESS
■
Proprietorship
■
Partnership
■
Corporation
■
LLC
Applicant Company Address
City State Zip
State of Incorporation Phone Number Date Incorporated
Nature of Business Years in Business
Company Website Email Address
Principal/Owner Social Security Number
Home Address Date of Birth
COMPANY INFORMATIONTRANSACTION INFORMATION
Distributor Name Representative
Location City State Zip Code Phone Number
Primary Contact Phone Number Email Address
DISTRIBUTOR
INFORMATION
DLL
®
and DLL Financial Solutions Partner
SM
are registered service marks of De Lage Landen International B.V.
EMAIL COMPLETED APPLICATION TO:
SC@FLORIDAFORKLIFT.COM
