NELC Vendor Portal

Apply For Lease

MAIN - Apply for Lease

Legal Business Name *

Contact Name *

Contact Direct Phone *

Billing Address

Billing City

Billing Zip Code *

Cost of Equipment *

Desired Lease-Financing Structure or Budget *

Vendor Name *

Vendor Email *

Vendor Phone *

Where Did You Find Us

State Business Formed In

Equipment to be Leased Financed (Please Describe)

Federal Tax Identification

Doing Business As (DBA)

Date Business Started

Number Of Years Under Current Ownership

Number Of Full Time Employees

Employee(s)

Number Of Part-Time Employees

Employee(s)

Contact Cell

Contact Fax

Contact Email

Best Time To Call

New or Used?

Year Built

Condition

Purpose Of Equipment

Equipment Location

Expected Delivery Date

Company Primary Bank

Contact & Phone#

Main Checking Account #

To expedite your request, please submit the top page of your company bank statement showing balance information from 3 most recent months.

Line of Credit or Other Loans, If any

High Credit Amount from Bank in Dollars

Accountant Contact & Phone#

Insurance Agent Contact & Phone#

Authorized Signing Officer Or Owner

Who Referred

Date Received

Activity Date

Amount to be Leased

Terms

Payment

Buyout

Signing Owner

Signing Owner Title

Percentage of Ownership

Social Security Number

Home Address

City

State

Zip

Phone

Status emails

Add Remove

Application ID

User ID