Application

To apply for your Rental or Lease Program, please complete the application below and click the Submit button. You will be contacted shortly thereafter about your application. The application is compatible with Microsoft Internet Explorer 6.0 and later. If you do not use this browser, please call us toll-free at 866-604-8160 extension 104 and we'll gladly take your application over the telephone. Thank You!

Reporter Information

How did you hear about us?
Program
Reporter Type
Years Reporting

Name
Address
City
State
Zip
How long at Address
Own or Rent
Home Phone
Cell Phone
FAX
E-Mail
Social Security Number
Key Top

Billing Plan
Name on Credit Card
Credit Card Type
Credit Card Brand
Credit Card Number
Credit Card Bank's Name
Credit Card Expiration
CVV2 Number (see below)

Students Please Complete Information Below:
Court Reporting School
School Phone
School Address
School City
School State & Zip
School Contact

Professionals Please Complete Information Below:
Equipment Supplier
Equipment Description
Equipment Cost
Finance Term
Supplier's Contact Name
Supplier's Phone Number

Comments or Special Instructions:

To protect both cardholders and us from stolen and fraudulent credit cards, please be sure you have correctly provided the following information before processing your application:

1). Your credit card number, name of card holder and the expire date.

2). The CVV2 value. The CVV2 value is a 3-digit number printed at the end of the credit card number on the signature panel on the back of the credit card.

Thank You for your application, by clicking the Submit button below, you are deemed to have signed and executed this rental application and acknowledge that your personal credit information may be checked by us or our assignees. If you do not wish to apply for credit, do not submit this application.

If you prefer to apply over the telephone, call us toll-free at 1-866-604-8160 extension 104.

STENORENT APPLICANTS: Upon submitting your application, your credit card will be charged for the $200 security deposit.

Thank You for your application, by clicking the Submit button below, you are deemed to have signed and executed this application and acknowledge that your personal credit information may be checked by us or our assignees. If you do not wish to apply for credit, do not submit this application. If you have provided credit card information you are deemed to have authorized us to charge your credit card for any funds owed in connection with this application.

Thank You - we appreciate the opportunity to serve your equipment financing needs!

Member:

Reporter Information

Copyright © 2006 StenoLease