NORTH AMERICAN RESOURCE CAPITAL, INC.
P.O. Box 5128, Hauppauge, NY 11788-0128 800-854-8515 631-265-7702 fax 631-265-7583 www.narcapital.com

Richard Cassiano			

								Attention:
LEASE APPLICATION

Business Information	
Lessee Name/dba:		
Address:		City:		
State:		Zip:		Fax:		Phone:		
Proprietorship    	Partnership     	Corporation     	Time in Business Under Present Ownership:		
Industry:		
Principal Name:		Title:		% of Ownership:		
SS#:		Address:		
City:		State:		Zip:		Phone:		
Principal Name:		Title:		%  of Ownership:		
SS#:		Address:		
City:		State:		Zip:		Phone:		

Transaction Information	
Equipment Cost:		Term:		Purchase Option:		
Payment Amount:	$	Advance Payment:	$	Security Deposit:		
Equipment Description:           New           Used		
	
Location of equipment, if different from business address:		
	
Supplier of Equipment:	SPEED-MAT, INC.	
Address:	770 Bath Rd.	
City:	Wiscasset	State:	Maine	Zip:	04578	Phone:	800-882-7017	
Contact  Name:	Matt Boutet	Fax:	207-882-9279	

References/Sources of Capital	
Business Bank:		Phone:  		
Contact:		Account #:		Checking   	Savings   	Loan   	
Account Name:		

Business Bank:		Phone:  		
Contact:		Account #:		Checking   	Savings   	Loan   	
Account Name:		
	
Trade:		Contact:		Phone:		
Trade:		Contact:		Phone:		
Trade:		Contact:		Phone:		

 Installment Debt Reference (Finance, Leasing, Bank)	
Name:		
Phone:		Contact:		Account #:		

By signing below, the undersigned individual as principal of and/or guarantor for the applicant, authorized North American  Resource Capital, Inc. its designee, assigns or potential assigns, to review  his/her personal credit profile provided by national credit bureaus in considering this Application and for the purpose of the update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. A fax or photocopy of this authorization shall be valid as the original	
Applicant Signature:		Date: