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Customer Information

Primary Lessee Information
Co-Lessee Information


  1. Declare and affirm that the statements made herein are true, correct and complete. You may contact any person or company that I have listed and I fully release all parties from any and all liability for any damage it may result.
  2. Understand and agree that a consumer report may be obtained in connection with my application.
  3. Understand that if applicable, Merchants Preferred Lease-Purchase Services will process an application fee at the time of contract preparation on the credit card provided.
  4. Understand that this application is subject to approval by Merchants Preferred Lease-Purchase Services at its offices in the State of Georgia and that all payments are remitted to Georgia.
  5. Understand this action counts as my electronic signature.