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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 Merchants Preferred Lease-Purchase Services will only charge an application fee/ initial payment (based on state requirement) to the card provided if a contract is prepared and generated.
  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.