LEASE APPLICATION Acct. Mgr.: Date: 15592 Computer Lane, Huntington Beach, CA 92649   Phone: (714) 897-1230; Fax: (800) 246-2339 Phone: FAX: For immediate consideration, please complete this form online. Print this form, sign and date the form and FAX it to us at (800) 246-2339 or mail, if you prefer. All information received is confidential. OLINPUMP Distributors   -   LEASING APPLICATION FORM Business Business Name/Lessee Phone Address FAX# City State ZIP Location of Equipment if other than above: CORP. Type of Business Age of Business # Years Current Owner Fed. Tax I/D # PART. Name of Corp. Secretary Install Date Date of Incorporation State of Incorp. PROPR. Comments: Ownership Banks Principal or Officer Spouse Title % Own Social Security # Home Address City St Zip Code Home Phone # Principal or Officer Spouse Title % Own Social Security # Home Address City St Zip Code Home Phone # Bank/Branch Date Opened Account# / Loan# Phone # Contact Officer Trades TRADE/LOAN REFERENCES Date Opened High Credit City/State Acount # Phone # Contact LANDLORD INFO $/MO TERM City/State Account # Phone # Contact Vendor Name Phone # FAX # Address City State ZIP Contact Equipment to be Leased Equipment Cost Equipment % Tax Amount Equipment  NEW:    OLD: Non-Tax Items Rate Factor Term Advance Payments Purchase Option Total Cost Signature: Date: Initials: (initials will be used as electronic acceptance of the aforementioned terms of this form.)