Short Equipment Lease Application                             *additional information will be required

*Legal Business Name/DBA: 

Address: 

City: 

   State:    Zip: 

*Phone: 

  Fax:    Web: 

*Primary Contact Name: 

  *E-Mail:

*Type of Equipment: 

*Cost of Equipment: 

For the purpose of obtaining credit, I certify that the information given in this application and any attached schedules is true and correct and the preceding statements, correctly reflect our financial condition as of the date indicated below and that there has been no material change since then. By submitting this application, I (the Individual as principal of and/or guarantor for the applicant) hereby authorize any financial institution or other credit reference to verify the information above or provide additional information which American Financial Group Leasing or its underwriters may request.  A fax or photocopy of this authorization shall be valid as the original. Completion of this application does not guarantee approval.