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London Leasing
London Leasing
London Leasing
London Leasing
London Leasing
London Leasing
London Leasing > Vendor Program / Apply Now > Vendor Application

Vendor Application - Online | (Click Here for a printable version of our Vendor Application)

Vendor Information
     
Legal Company Name Telephone Fax
       
Company Address City State Zip
       
Contact Name Title Email Address
     
Website Address Authorized Distributor For: Hardware Manufacturer:
     
Type of Business Tax ID Number
       
Years in Business (Min. 2yrs.) Number of Employees Average Sale ($) Annual Sales ($)
   
Annual Lease Volume Current Leasing Company
   
Means of Distribution (Check all that apply)  
   
Markets Served Customer Mix Consumer (%) Customer Mix Commercial (%)
     
 
Equipment Information
 
Equipment Description
 
Equipment If Used, State Max Age If Used, State Average Age  
 
       
Primary Bank Reference (Two Year History)
       
Bank Name Account #(s) Phone # Officer's Name
       
Address City State Zip
       
Bank Name Account #(s) Phone # Officer's Name
       
Address City State Zip
       
Principal / Owner Information
     
Name Title SSN
       
Address City State Zip
       
Telephone Email Mobile
     
ACH Information
(By completing this ACH section, we will be able to pay your invoice through automated deposit into your account.) COPY OF VOIDED CHECK REQUIRED VIA FAX OR EMAIL
     
Name on Account Account Type Account #
     
Bank Name ABA Routing # Bank Phone #
       
Address City State Zip
       
Declaration
 
This application submitted electronically shall have the same force and effect as if the application bore an inked original signature(s). The above information, together with any accompanying financial statements, schedules, or other materials, is submitted for the purpose of obtaining credit and is warranted to be true, correct and complete. The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his/her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and shall hold LONDON Leasing and its assignees, agents or nominees harmless from same. You understand that such investigation may include seeking information as to the background, credit and financial responsibility of your officers and principals (or any of them). The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please write to LONDON Leasing., 2635 East Millbrook Road, Raleigh, NC 27604.