Mosaic International Corporation : Equipment Lease Financing Specialists  

Call us toll-free within the U.S. 1.800.805.1969

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Online Commercial Equipment Lease Financing Application
Items in bold are required.

LESSEE INFORMATION
Legal Name of Company:
 Telephone Number:
 Fax Number:
Contact Person:
 Title:
 Email Address:
Trade Name:
 Type of Business:
Proprietorship    S Corporation    C Corporation    LLC
Company Address:

 Years in
Business:
 Number of
Employees:
 Years at
current location:
City:
 County:
 Business Property:
Own    Lease		 Industry:
State/Province:
 Zip/Postal Code:
 Federal ID Number:
 Duns Number:
Have you applied for an equipment lease in the past 90 days?    Yes    No
BANK REFERENCES
If you would like to include more than two bank references, please fax the additional information to 612.395.5235
Bank Name:
 Branch:
 City:
 State:
 Telephone:
 Contact Name:
 Account #:
TRADE OR FINANCE REFERENCES
If you would like to include more than two trade references, please fax the additional information to 612.395.5235
Company Name:
 City:
 State:
 Telephone:
 Contact Name:
 Account #:
PRINCIPAL / GUARANTOR INFORMATION
If you would like to include more than two principals or guarantors, please fax the additional information to 612.395.5235
FIRST PRINCIPAL OR CORPORATE GUARANTOR
Name:
 Professional Title:
 Home Phone Number:
 Ownership %:
Home Street Address:
 City:
 State/Province:
 Zip/Postal Code:
SECOND PRINCIPAL OR CORPORATE GUARANTOR
Name:
 Professional Title:
 Home Phone Number:
 Ownership %:
Home Street Address:
 City:
 State/Province:
 Zip/Postal Code:
VENDOR / EQUIPMENT INFORMATION
If you would like to include more than one vendor, please fax the additional information to 612.395.5235
Vendor Name:
 Contact Name:
 Telephone:
 Email Address:
 Vendor Web Site:
Street Address:
 City:
 State/Province:
 Zip/Postal Code:
Total amount to be leased including shipping and installation:  $
Equipment Description:

Once you have submitted this form by clicking on the button below, you will be directed to the Credit Release page. We cannot process your application until we receive your completed Credit Release.

Please PRINT, FILL-OUT, SIGN and FAX the Credit Release
to Mosaic International Corporation at 612.395.5235

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1229 Third Street, Suite 201  ·  Int'l Falls, MN 56649       Phone: 800.805.1969 or 218.285.7421       Fax: 612.395.5235 or 612.395.5235
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