N.S. Machine Corporation

Credit / Lease Application

1. Print this form.	1503 S. Ankeny Blvd Ankeny, Iowa 50023
2. Fill out the form and sign it.	Phone:515-964-1290
3. Mail or Fax a signed copy to us	Fax: 515-964-7484

-BUSINESS INFORMATION-

Legal Business Name: ____________________________________________________________________________________________________________
Sole Proprietorship: ______	Partnership: ______	Corporation: ______
Address:__________________________________________________________________________________
Phone: (____)_____________________________	Fax: (____)________________________________	Years in business: __________________
Business description: _______________________________________________________________________		Tax ID#: _________________________

-BUSINESS BANKING REFERENCES-

Bank: ____________________________________	Phone: (____)_____________________________	Account: _________________________________
Bank: ____________________________________	Phone: (____)_____________________________	Account: _________________________________

-TRADE REFERENCES (Include Other Equipment Leases)-

Company: _________________________________	Phone: (____)_____________________________	Account: _________________________________
Company: _________________________________	Phone: (____)_____________________________	Account: _________________________________
Company: _________________________________	Phone: (____)_____________________________	Account: _________________________________

-OWNER / PRINCIPAL INFORMATION-

Name of Signator: __________________________________________	Title: _______________________________________________________
Home Address: ___________________________________________________________________________________________________________________
Home Phone: (________)_____________________________________	Social Security #: _____________________________________________
Name(s) of other owner/principal(s): ___________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________

-EQUIPMENT DESCRIPTION-

Type of Equipment: _______________________________________________________________________________________________________________
Approximate cost: $_____________________________	Preferred Lease Term:	_____12	_____24	_____36	_____48	_____60

-SIGNATURE & AUTHORIZATION-

I authorize the lessor to make whatever credit inquireies that it deems necessary in connection with this lease application. I authorize any person or financial institution to complete and furnish to the Lessor any information that it may have or obtain in response to such credit inquires. I declare all information set forth in this lease application to be a true representation of the facts and I acknowledge that any willful misrepresentation on this lease application could result in criminal action.
Date: ________________________	Signed: ____________________	Title: ________________________

© 1999 NS Machine Corporation. All rights reserved.