2 Minute Application

PDF Version of Form

Please complete and return to Bankers Leasing Company via email to welcometoblc@banleaco.com, fax to 800-342-6855 or mail to PO Box 7740, Urbandale, IA  50323.  If you have any questions please contact customer service at 800-247-8136 x 306.

To submit an application online, complete the simple form below:
Your Name: *
Your E-mail Address: *

Business Information Legal Business Name: *
Business Address: *
City: * State: * Zip: *
Business Phone Number: *
Business Type:
Tax ID#:
License Type:
If Other, Explain:

Personal Information Name: *
Address: *
City: * State: * Zip: *
Cell Phone Number: *
Home Number:
Social Security Number: *--

Equipment Information Type of equipment you are interested in: *
Approximate Cost of equipment: *
Supplier/Vendor of equipment: *
Supplier Phone Number: *
Sales Rep:
Rep Phone Number:

This application is true and correct, and is given to obtain credit from Bankers Leasing Company, Urbandale, Iowa, or its designee, assigns or potential assigns for the purpose of extending credit to the applicant. My initial in the below text field authorizes all bank and trade references to release relevant information for the purpose of obtaining credit from Bankers Leasing Company.


Please initial in the field below if you agree: