Apply for Equipment Leasing in Alberta

EQUIPMENT TO BE LEASED

Description *ELOG 2 year SolutionELOG 3 year solution

Number of Units *

Monthly Cost / Unit including data (plus applicable taxes)

Pricing For <10 Units

Pricing For 10-50 Units

Pricing For >50 Units

Required Installation Date *

APPLICANT INFORMATION

BUSINESS INFORMATION

Full Legal Name *

Operating As (trade name)

# of Employees

Select One *

Date of Incorporation *

Have you been in business for less than 5 years? *

YesNo

OWNER INFORMATION

Home Address Owner 1 *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Name of Owner 1 *

Date of Birth Owner 1 *

SECOND OWNER INFORMATION

Name of Owner 2 *

Date of Birth Owner 2 *

Home Address Owner 2 *

Apartment, suite, etc

City *

ZIP / Postal Code *

BUSINESS INFORMATION

These units are for

Street Number (# only) *

Street Name *

Suite No.

City *

Select Province/State *

Postal/Zip *

Select Country *

Website *

Email Address *

Phone *

Cell

Contact

Type of Hauling *

Geography *

RegionalInterprovincialCanadaNorth America

Bank *

Branch *

How Long? *

Account #

Any comments or questions?

The undersigned certifies the above information to be true and correct. By signing below, I consent and authorize the following entities: Prime Capital Group Inc., Xpedite Leasing Inc., and 941315 Alberta Ltd., (collectively known as Prime Capital Group) and its representatives, and any potential credit grantor assignee, at any time to obtain on an on-going basis, verify use, communicate with and disclose to third parties (including credit reporting agencies, credit exchanges, leasing brokers, on an on-going basis) any of my credit, financial, and personal information that Prime or its agents or affiliates deems necessary to complete, service or enforce any lease, ancillary deed or transaction, including but not limited to assignments and securitizations. We acknowledge that you or your financing partners may transfer and store information to jurisdictions where you or your financing partners do business. As a result, information may be accessible to regulatory authorities in accordance with the laws of these jurisdictions.

You authorize us to collect, hold, exchange and disclose your personal information as requested in order to administer your contract & determine your insurance eligibility as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. If you would like to review your own personal information, correct or revise existing information, have any questions, concerns or comments regarding its application please fax 1-780-437-7268 (Attn: Privacy Office) or mail #215, 625 Parsons Road SW Edmonton AB T6X 0N9 Attn: Privacy Office.

Electronic Acknowledgment (Applicant) *

I, the Applicant, certify the above to be correct and I authorize Prime Capital Group to process my information.

Electronic Acknowledgment (Company Principal) *

I, the Company Principal, certify the above to be correct and I authorize Prime Capital Group to process my information.

Have you been in business for less than 5 years? *

Geography *

Electronic Acknowledgment (Applicant) *

Electronic Acknowledgment (Company Principal) *

Lease the equipment you need today &

stay cash rich.