Graphic Shopper.com

This lease application shall be processed by Champion Capital. If you have any problems or questions please do not hesitate to email us by clicking here.

Name:			Phone #:
Address:			Suite:

City:

State:

Zip:

Signer:

Nature of Business:

# Employees:

# Years in Business:

Type of Business:

Corporation

Proprietorship

Non-Profit

Partnership

Federal Tax ID #:

Vendor Name:		Phone #:
Equipment Description:
		Cost:

Term:		Rate:		# Advance:
Monthly Payment:				Purchase Option:

Name:		Social Security #:
Home Address:

City:		State:
Zip:		Apt.:

Name:		Social Security #:
Home Address:

City:		State:
Zip:		Apt.:

Bank Name:	City:		State:
How Long:	Contact Officer:		Phone #:
Check Acc #:		Loan Account #:

Name of Supplier:		Phone #:
Contact Person:

Name of Supplier:		Phone #:
Contact Person:

Name of Supplier:		Phone #:
Contact Person:

By submitting this form you give your authorization to release any information requested concerning your personal or business accounts to Champion Capital and GraphicShopper.com. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purpose of update, renewal or extension of such credit and for reviewing or collecting the resulting account.