Business Name..........*
Trade Style................
Main Contact.............* Title:
Address.....................
City..........................*. Prov: Ont BC Alta Sask Man Que NB NS PEI Nfld Nan NWT Yuk PC:
Voice Phone................Fax:
E-Mail.......................*.
Years in Business:......If Incorporated - Date:MMM/DD/YY
Type of Business ....... Corporation Partnership Proprietorship Non Profit Church Government Other Other:

LEASE DETAILS

Vendor Name * (Vendor information optional)
Address........
City............... Prov: Ont BC Alta Sask Man Que NB NS PEI Nfld Nan NWT Yuk PC:
Voice Phone...Fax:

Equipment to be leased*

Expected delivery Date mm/dd/yy

Price................*..Cdn$ Exclude PST & GST
Lease Term .....*. 24 Months 25% Option 24 Months $1 Option 30 Months 20% Option 36 Months $1 Option 42 Months 20% Option 48 Months $1 Option 54 Months 15% Option 60 Months $1 Option 65 Months 10% Option Other Term & Option

Requested by* Name & Title