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Don Berryhill
Member, American Society for Laser Medicine and Surgery (www.aslms.org)
Published Articles
Office: 936-273-2721
Cell: 281-935-2030
Fax: 936-273-4268
don@lasercoach.com
Houston, Texas
Equipment Leasing Information  |  Lease Application Example

Laser / Equipment Lease Application Example
Below is an example online lease application. It includes the information generally required during the application process. Note: The form below is ONLY for demonstration purposes. Contact me today for help finding a responsive lease company specializing in lasers and medical equipment.
First Name MI Last Name Profession
Business Address Suite
City State Zip
Business Phone Extension Business E-mail
Social Security License Number
Date Issued: Mo/Day/Year Date of Expiration: Mo/Day/Year
 
I am interested in buying/selling a practice.


Supplying the following optional information will help us understand your future needs.
Company
Business Fax Area Tel Phone Business Pager Area Tel Phone
Home Address Suite or Apt
Home City Home State Home Zip
Home E-mail Home Telephone Area-Tel-Phone
Home Pager Area-Tel-Phone Home Fax Area-Tel-Phone


Please Enter A Dollar Amount
Equipment
Working Capital
Leasehold Improvements
Furniture
Computers
Software
Loan Consolidation
Practice Equity Loan
Lease or Finance
I would like a lease with a 10% purchase option.
I would like a finance agreement.
Length
12 months
24 months
36 months
48 months
60 months
72 months
84 months


Deferment
People sometimes choose to defer because the cash flow of their business may be limited while they're starting out and waiting for reimbursements from the patients' insurance companies.
30 Day Deferred
60 Day Deferred
90 Day Deferred
None
Payment Options
First Payment
Last Payment
Security Deposit

By choosing to make any of the above payments you can actually lower your monthly payments.
Equipment Leasing Information  |  Lease Application Example
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