CREDIT APPLICATION

The following is LPI's Credit Application. In order to qualify customers, we need to have this Credit Application completed to give us a better idea what type of credit you are. Please fill out the form in its entirety so that we do not have to have any delays in the credit process. If you have any problems with this document, please send an e-mail to webmaster so that we can fix any problems in the application.

LPI Fax# for sending additional information: 610.687.4215

To download the application in .pdf format, click here Credit Application.

To download the application in word format, click here Credit Application.

Note: Fields in red are required

Background Information

Legal Company Name:

Address:

City: State: Zip Code:

* Phone: * Fax:
* Please enter phone number with 10 digits (no dashes, etc)

E-Mail Address:   

D&B Rating: Tax ID #:

Organization Type: Corporation Sub S Partnership Proprietorship

Years in Business:    Duns Number:

State of Incorporation:    Number of Employees:

Type of Business (Industry/Product):

If a corporation, is it: Privately Held - or -  Public

 

Bank/Trade Information

Bank Name:

* Phone: * Fax:
* Please enter phone number with 10 digits (no dashes, etc)

Checking Account Number:

Account Officer:

Borrowing Relationship? Yes No

SUPPLIER INFORMATION   (Trade Creditors)

1. Name:

Contact:      

* Phone:    * Fax:
* Please enter phone number with 10 digits (no dashes, etc)


2. Name:

Contact:     

* Phone: * Fax:
* Please enter phone number with 10 digits (no dashes, etc)


3. Name:

Contact:   

* Phone: * Fax:
* Please enter phone number with 10 digits (no dashes, etc)

Lease Request

Software and/or Equipment Description:

Cost:    Lease Term Requested: Years   

Payment Frequency:  If Other, explain:

Billing Contact:

Address of Leased Item(s): (Please complete if different from the above address):

Vendor Name:

Vendor Contact:

* Phone: * Please enter phone number with 10 digits (no dashes, etc)

How soon will you be making a decision to acquire the software:

Would you like an Account Executive to give you a call to answer any additional questions?Yes   No

By submitting this application electronically, you agree: that all information is true and correct; that LPI Software Funding Group, Inc. (?LPI?) is authorized by you and any guarantors to obtain credit information from all sources on you and those guarantors; that by placing your name and title and submitting this application you intend to sign this application electronically; that the guarantors by placing their name and social security number and submitting this application the guarantors also intend to sign this application; and that the application was effective only upon receipt by LPI at its offices in Wayne, PA.

Agreed and Electronically signed by:

Contact - First  & Last Name:  

Contact Title:


 GUARANTORS

If Privately Held, List Majority Owners:

1. Name:

Address:

City, State, Zip:  

Social Security No.  % of Ownership:
Please enter 9 digits (no dashes)


2. Name:

Address:

City, State, Zip:

Social Security No. % of Ownership:
Please enter 9 digits (no dashes)

If Private and cost is greater than $50,000, please supply us with your most recent year-end financials and any interim financials you may have.  You may fax them (Fax# 610.687.4215) or send or email them to us.  See below for our address. 

(C) LPI Software Funding Group, Inc.

593 Cricket Lane, Suite 200     Wayne, PA 19087
Phone: 610.687.4434  or 610.341.6100   Fax: 610.687.4215

sales@lpilease.com
  March 6, 2006