Software Lenders | Applications for Software Lease Financing

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Software Lenders (A Division of Mosaic International Corporation)

Call us toll-free within the U.S. at 1.800.805.1969 or 218.285.7421

Software Lease Applications
for businesses looking to lease software solutions

Online Software Lease Application
Our online application is the preferred method of getting your software lease application to us. It is quick, easy and and doesn't require any additional software. Just fill out the form shown below.

Alternate Software Lease Application
If you would rather fax your application, click here to open the alternate application in a new window. Once you see the application on your screen, print it, fill it out completely, sign it and fax it to 218.285.7422


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 info to 218.285.7422)
Bank Name:	Branch:	City:	State:	Telephone:	Contact:	Account #:

TRADE OR FINANCE REFERENCES (If you would like to include more than two trade references, please fax the additional info to 218.285.7422)
Company Name:	City:	State:	Telephone:	Contact:	Account #:

PERSONAL INFORMATION (If you would like to include more than two principals or guarantors, please fax the additional info 218.285.7422)
FIRST PRINCIPAL OR GUARANTOR
Name:	Professional Title:	Home Phone Number:	Ownership %:

Home Street Address:

City:

State/Province:

Zip/Postal Code:

SECOND PRINCIPAL OR GUARANTOR
Name:	Professional Title:	Home Phone Number:	Ownership %:

Home Street Address:

City:

State/Province:

Zip/Postal Code:

SOFTWARE VENDOR INFORMATION (If you would like to include more than one vendor, please fax the additional info to 218.285.7422)
Vendor Name:	Contact Name:	Telephone:	Email:	Web Site:

Street Address:

City:

State/Province:

Zip/Postal Code:

Total amount of software lease: $

Does the total lease amount include installation & training costs? Yes No

If yes, how much? $

Name and Description of Software:

	Once you have submitted this form by clicking on the button above, you will be directed to the Credit Release page. Please PRINT, FILL-OUT, SIGN and FAX the Credit Release to Software Lenders at 218.285.7422.



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Copyright 2005-2007 © Mosaic International Corporation dba Software Lenders. All rights reserved. Toll-free within the US: 1.800.805.1969 Phone: 218.285.7421 Fax: 612.395.5235 or 218.285.7422 Parkway Plaza · 1229 Third Street, Suite 201 · International Falls, Minnesota 56649