Online Lease Application
*Note: You must enter your email address to submit this form.
Vendor Information
 
Vendor Name: Equipment Description:
Vendor Address: Equipment Cost:
Vendor Phone: Contact:
City, State, Zip: Vendor Fax:
 
Business Information
 
Business Name: Business Phone:
Nature of Business: Business Fax:
Business Address: *Email:
City, State, Zip: Years in Business:
Type of Business:
 
Personal Information
 
Principal #1
Name: Home Phone:
Home Address: Own Home:
City, State, Zip:    
 
Principal #2
Name: Home Phone:
Home Address: Own Home:
City, State, Zip:    
 
Bank Information
 
Primary Bank
Name and Branch: Bank Contact:
Bank Phone: How Long:
 
Secondary Bank
Name and Branch: Bank Contact:
Bank Phone: How Long:
 
Trade References
 
Reference #1
Name: Contact Phone:
Contact Name: Terms:
 
Reference #2
Name: Contact Phone:
Contact Name: Terms
 
Reference #3
Name: Contact Phone:
Contact Name: Terms:
 
Only click once, it will go through.
 
Please note that your Social Security Number and Bank Accounts will be required upon loan verification.
Bavarian Breweries and Distilleries
Phone: (310)391-1091   Fax: (310)391-4530
Email: stills@potstills.com