Lease Application

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Complete an application in one of these convenient ways:

Complete the on-line express application below
Download a form to complete and fax back to 720-294-9855
Call Ernie Perry today at 800-280-1980
Email your information to

Restaurant Source
5005 Washington St.
Denver, CO 80216
Ph: 303.296.1684
Fx: 303.297.2711

C&W Leasing
Pinnacle Business Capital
Ernie Perry
Ph: 303.216.2980
Fx: 720.294.9855
Ph: 800.280.1980

Company Information

Full Legal Company Name
Address
City	County	State	Zip
Contact Person	Telephone	Fax
Nature of Business	Fed. Tax ID #	Time in Business

Vendor Information

Amount	New or Used
Equipment Description

Corporation

Proprietorship

Non-Profit

Partnership

LLC

Location of Equipment (if different than above)	Years at this Location
Email Address

Personal Information for all Owners, Officers and Guarantors

Name	Title	SSN	%Ownership
Home Address / City / State / Zip			Home Phone Number
Name	Title	SSN	%Ownership
Home Address / City / State / Zip			Home Phone Number

Credit Authorization:
Credit Authorization: I/We hereby authorize Pinnacle Business Capital, its designee, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of updating, renewing, extending additional credit or the collection of any late account. I/We hereby authorize our references to release all credit information and I/We represent and warrant that the information submitted herein is true, complete and accurate. A facsimile, electronic or other copy of this authorization shall be as valid as the original

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