Welcome to Westport Leasing.

Please complete this application and click on the Submit button below. To print a PDF Copy click here. Please be sure to include Area Codes for all Phone and Fax numbers.

Company Information
Company Name
Address
City/Prov/State
Post/Zip Code
Phone Number
Fax Number
Contact Name
E-Mail Address

Equipment Information
Description
Condition	New Used Reconditioned
Pretax Cost
Currency	Canadian US Dollars
Supplier Name
Sales Person
Phone Number
Fax Number
Term Requested

THE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION TO BE TRUE AND CORRECT. I/WE HEREBY AUTHORIZE WESTPORT LEASING CORPORATION AND/OR ITS THIRD-PARTY AGENTS, OR ASSIGNS (WESTPORT) TO COLLECT, RETAIN, USE, DISCLOSE & EXCHANGE CREDIT REPORTS, BANKING & CREDIT REFERENCES, AND OTHER PERSONAL INFORMATION FOR ALL PURPOSES RELATED TO CONFIRMING IDENTITIES, THE EVALUATION OF CREDIT WORTHINESS, PROVIDING LEASING AND/OR OTHER FINANCIAL SERVICES, ADMINISTERING CONTRACTS, REGISTERING SECURITY INTERESTS, PERFORMING INTERNAL STATISTICAL ANALYSIS, REPORTING ACCOUNT INFORMATION TO CREDIT AGENCIES AND OTHER CREDITORS, AND/OR OTHER PURPOSES AS REQUIRED OR PERMITTED BY LAW. I/WE ACKNOWLEDGE THAT FILES CONTAINING MY/OUR PERSONAL INFORMATION MAY BE KEPT AT WESTPORT'S OFFICES AND THAT I/WE HAVE A GENERAL RIGHT TO ACCESS AND RECTIFY PERSONAL INFORMATION IN THE FILES BY SUBMITTING A WRITTEN REQUEST TO WESTPORT.

If this form is being faxed, send to (604) 681-1260 or 1 (800) 667-0747
Please sign and date on the line below.

X______________________________________________________ Date:_____________________