Phone: 201-568-1881

Fax: 201-568-0166

LEASE VERIFICATION CHECKLIST

Initial(s)

Required

_________ The equipment has been installed, it is in working order, and I have been trained on

(Initial here) how to use it.

_________ I understand that the lease I signed is NON-CANCELLABLE for _______ months

(Initial here) at a basic monthly payment of $__________ (excluding tax and insurance) for which Integrated Leasing Corp (Lessor) has been authorized to debit my business checking account.

_________ This lease is a binding agreement between the Lessee (undersigned below) and

(Initial here) Integrated Leasing Corp (Lessor). I understand that the salesperson(s) or supplier is NOT an agent of Integrated Leasing Corp (Lessor) and does not have the authority to waive or alter any terms or conditions of the lease.

_________ I understand that the warranty of the equipment is the responsibility of the manufacturer

(Initial here) salesperson(s), or supplier, not Integrated Leasing Corp (Lessor).

_________ I have read and agree to all terms and conditions of the Lease Agreement, and have not

(Initial here) relied on any representations of any salesperson(s) or supplier.

_________________________________________________ __________________

Business Name County

X________________________________________________ __________________

Principal Owner/Authorized signer signature Social Security # (last four digits)

__________________________________________________

Printed Name/Title/Date ______________________

Co-Signature

C. Taylor______________________________________

Printed name and signature of witness

Equipment Description: Serial #:

____________________________________ __________________________________

ISO Code: LCCT 000033400