Graphic Savings Group LLC
457 Castle Avenue , Fairfield , CT 06825
Phone: 203.336.4034, Fax: 203.549.0476

Contact Information
*Legal Organization Name:		Doing Business As (DBA):
*Main Business Phone:	-- ext:	*Contact Person:	First Name: Last Name:

*Contact Title:
*Contact Email:	Confirm Email:

*Contact Phone:

--
ext:

Secondary/Cell Phone:

--
ext:

Fax:

Best time and contact number to reach you if necessary (150 character max):

* Yes, I am authorized to apply for a lease on behalf of .

Your Organization

*Type of Organization:

Corporation	Proprietorship
Partnership L.L.C.	Non-Profit/Other

*Organization Address:

Address1:		Address2:
City:		State:
Zip:		Country:

Federal Employee Tax ID:

*Are you Subsidiary Branch/Division Location?

Yes No
Name of Parent Organization
Parent Organization Address
City:	State:
Zip:	Country:
Parent Organization Phone - - ext:

Business Banking Information
*Bank Name:
*Address:
*City:
*State:
*Zip:
*Phone:
Bank Contact
*Business Account#

What equipment are you looking to lease?

Model

Make

New

Used

How did you hear about us

Referral	Email
Search	Print Ad
Seminar	News Article
Other

Additional Information or Comments :

By selecting "I Agree,"I authorize you or your designee to verify the information on this application and to receive and exchange information about me including requesting reports from consumer or corporate reporting agencies.I understand that all information provided in this application must be verifiable and accurate.

I agree

Please have a representative contact me.

457 Castle Avenue , Fairfield , CT 06825
Phone: 203.336.4034, Fax: 203.549.0476