* Indicates a required field

Company Information
*Lessee Full Company Name:
*Lessee Full Company Address:
Address 2:
*City:
*State/Province:
*Zip/Postal Code:
*Date Established:
*Telephone Number:
Fax Number:
*Federal Tax Number:
*Type of Business:	Choose One Performance Shop Automotive Service Center Diesel Service Retailer Manufacturer
	Proprietor Partnership Corporation
Banking Information
*Bank Name:
*City:
*State:
*Telephone Number:
*Fax Number:
*Bank Contact:
*Account Number:
Bank Name:
City:
State:
Telephone Number:
Fax Number:
Bank Contact:
Account Number:
Personal Information (Principals or Guarantors)
*Full Name:
*Address:
Address 2:
*City:
*State/Province:
*Zip/Postal Code:
*Telephone Number:
*Social Security #:(no dashes)
*% Ownership:
*Title:
Full Name:
Address:
Address 2:
City:
State/Province:
Zip/Postal Code:
Telephone Number:
Social Security #:
% Ownership:
Title:
Full Name:
Address:
Address 2:
City:
State/Province:
Zip/Postal Code:
Telephone Number:
Social Security #:
% Ownership:
Title:
Trade References - please provide 3 trade references (required)
* Company Name:
* Telephone:
* Contact Name:
Account Number:
* Company Name:
* Telephone:
* Contact Name:
Account Number:
* Company Name:
* Telephone:
* Contact Name:
Account Number:
Lease Information
*Equipment Price Range:	Choose One 0 - $10,000 (MD-66) $20,000 - $30,000 (MD-100, MD-250) $30,000 - $65,000 (MD-1750, IMPORTDyne, MD-750) $50,000 - $70,000 (MD-AWD-500, MD-1000)
*Term:	Choose One 36 Month 48 Month 60 Month
*Purchase Option:	Choose One 10 % Purchase Price $ 1.00
*Program:	Choose One Standard 7 x $100 Program Seasonal

Credit Release

I authorize Mustang Dynamometer or its assigns to make whatever credit inquiries necessary in connection with this credit application. I authorize any person or financial institution to complete and furnish any information that it may have in response to such credit inquiries, I declare all information set forth in this credit application to be a true representation of the facts.