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2nd Guarantor Name:
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Trade Reference 1: City/St:
Telephone: Fax: Contact:

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I hold the following credit cards (DO NOT give card numbers)  Visa  M/C   Discover   AmEx  None

If you wish to add information that may induce reviewing officer to grant credit or extend a lower rate, please enter it in the box below:

LEASE WILL BE CONSIDERED IF COST OF EQUIPMENT IS NOT LESS THAN $2000.00 BEFORE SALES TAX. LEASES FOR LESS THAN $2000 NOT AVAILABLE.
Cost of Equipment:    This includes Sales Tax? Yes No  Proposed Rate:
Proposed Terms or Special Arrangement, if any:

Notice from Fred Stock Electronics / TaxiCabElectronics.Com inclusive:

Fred Stock Electronics acts as provider of equipment and services and does NOT finance, lease or otherwise sponsor this transaction except as sales agency. This application will be submitted to a proper leasing company for consideration by their professionals. Information contained in this application is never shared with others except for this purpose, and is to be held confidential.

Notice from Lessor:

"We (lease company) understand you are considering instructing us to purchase from Fred Stock Electronics the equipment described in the attached lease agreement on your behalf as Finance Lessor. Please be advised that under Article 2A of the Uniform Commercial Code you are entitled to all promises and warranties provided to us by the person supplying or manufacturing the equipment, and that you are entitled to receive from the supplier or manufacturer an accurate and complete statement of those promises and warranties, including all disclaimers and limitations."

Notice from Lessee:

"We (prospective lessee) hereby request and authorize you to whom this application is made, or your agents, to investigate my credit-worthiness, and will provide financial statements, tax returns etc. at your request. In consideration of your efforts, we agree that the limited security payment is not refundable. By the execution of the lease agreement, we warrant the information provided herein is true and correct, and hereby authorize references herein to release any information necessary. Further, we warrant it is understood the lessor reserves the right to reverse any credit decision if the information is found to be incorrect, and we (prospective lessee) will indemnify the lessor for any and all costs incurred with this application for credit including any cost incurred in the placement or reservation of the intended leased equipment based on the information contained herein. We hereby request any above named entity to consider this to be our written request for release of all information requested by the lessor to the lessor. We hereby acknowledge receipt of a copy of this application. If our application for business credit is denied, we have the right to a written statement of the specific reasons for denial. To obtain a written statement, we shall send a written request to the address above. We understand when such a request is received by Fred Stock Electronics, it will be forwarded to the lease agency through whom the application was denied for written response within 30 days of receipt of our request for such statement. We hereby warrant that all of the information above is true and correct to the best of our knowledge.

SIGNATURE of APPLICANT: Date:
SIGNATURE of GUARANTOR 1: Date:
SIGNATURE of GUARANTOR 2: Date:

Please fill in all information requested, check it carefully, and then press SUBMIT button. This will transfer your information via e-mail to our office. You will receive a message verifying that the material has been sent. You will eventually be sent "original" forms requiring your "wet signature" and a copy of your lease contract with instructions for further signatures or information if required. You may also choose to print this form in its entirety for your records. We will correspond with you as the lease application progresses through the process. Submission of this form DOES NOT GUARANTEE your acceptance by the leasing company. You may call 760-345-4347 for assistance with this form if necessary.  If you wish to copy and fill out this form manually, you may fax it to 760-345-6947.

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