Welcome to Execucor Financial Ltd.

Lessee
Company Name:
Address:
City:		Province:	Postal Code:
Phone:		Fax:
Nature of Business:		Time in Business:
Contact EMail:

Principal Owner #1
Name:
Address:
City:	Province:
House:	Market Value: $
How Long?	Mortgage:
Date of Birth:	S.I.N.
Personal Bank:	Branch
Telephone:	Contact
Account Number:

Principal Owner #2
Name:
Address:
City:	Province:
House:	Market Value: $
How Long?	Mortgage:
Date of Birth:	S.I.N.
Personal Bank:	Branch:
Telephone:	Contact:
Account Number:

Business Bank
Bank:
Branch:
Telephone:
Contact:
Account Number:
Previous Bank/ Trade References/ Comments:

Equipment To Be Leased
Equipment Description:
Vendor(s):
Equipment Cost:
Deposit:
Net to Finance:
Term:
Payment: