Online Credit Application Form

Completing the required fields takes 5 minutes.
This information is solely for the use of
C and J Leasing and will not be used in any
way other than lease determination.

Required Information.
Business Name:
     Business Type:
Contact Name:
   Time in Business: (Yrs / Mos)
Address:
   Total $ Amount Requested:
City:
  For What Merchandise?
State:
   Bank Name:
Zip Code:
   Bank Account #:
Telephone:
   Cell Phone:
Bank Phone:
   Email:
Name of Contact Person at Bank:
  

Optional Supplier Information.
This requested information will help us determine your lease.
Supplier Name:
Supplier Phone:
Supplier Address:
Supplier City:
Supplier State:
Supplier Zip Code:
Supplier Contact Name:
Supplier FAX:
Supplier Email:

Optional Lessee Information.
(If you are not a corporation, we will need this information also)
Owner's Name:
Owner's Home Address:
Owner's City:
Owner's State:
Owner's Zip Code:
Owner's SSN:
Owner's DOB:
Owner's Home Phone:
Co-Owner's Name:
Co-Owner's Home Address:
Co-Owner's City:
Co-Owner's State:
Co-Owner's Zip Code:
Co-Owner's SSN:
Co-Owner's DOB:
Co-Owner's Home Phone:



C and J Leasing
P.O. Box 8219 • Des Moines, IA 50301 • Local (515) 224-9200
Toll Free WATS 1-800-779-1079 • Local FAX (515) 327-5180
Toll Free FAX 1-800-779-0079