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    Applicant Information

    [text legal-name]
    [text YearInBusiness]
    [text OperatingAs]
    [text GrossYearlyRevenue]
    [text Address]
    [text City]
    [text PostalCode]
    [select Province "AB" "BC" "MB" "NB" "NFLD" "NS" "NWT" "ON" "PEI" "QC" "SK" "YK"]
    [text main-content]
    [text title]
    [radio SigningAuthority "Yes " "No"]
    [text AppPhone]
    [email* your-email]
    [text AppCell]

    Principal Details

    [text prinicpalname1]
    [text prinicpalname1]
    [text principalbirthday1]
    [text principalshare1]
    [text principalresaddress1]
    [text principalcity1]
    [text principalpostalcode1]
    [text prinicpalprov1]
    [text principalemail1]
    [email* prinicpal-email1]
    [text prinicpalname2]
    [text prinicpalname2]
    [text principalbirthday2]
    [text principalshare2]
    [text principalresaddress2]
    [text principalcity2]
    [text principalpostalcode2]
    [text prinicpalprov2]
    [text principalemail2]
    [email* prinicpal-email2]

    Equipment Lease Details

    [text LeaseSupplier]
    [text LeaseContact]
    [text LeasePhone]
    [text SupplierEmail]
    [text Other]
    [text Description]
    [radio DescriptionNewUsed "New " "Used"]
    [text EquipmentValue]
    [select Term "24" "36" "48" "60" "72"]
    [radio PaymentFrequency "Seasonal" "Monthly" "Quarterly" "Semi-annual" "Annual"]

    Financial Reference

    [text BankName]
    [text FinancialContact]
    [text HowLong]

    [checkbox* checkthisbox "* By checking this box, I consent to the obtaining, from any credit reporting agency grantor, such information as Calidon Equipment Leasing may require at any time in connection with the credit hereby applied for and consent to the disclosure at any time of any information concerning the undersigned to any credit reporting agency or to any credit grantor with whom the undersigned has financial relations."]

    [submit "Submit Form"]

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