Lease Agreement
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LEASE AGREEMENT
Note: This Lease Agreement should be maintained in the Equipment during the term of the Agreement.
I.
I, _________________________________________________________________________ (Carrier/Registrant)
Address: _______________________________________________________________________________, and
___________________________________________________________________________(Equipment Owner)
are parties to a written Lease Agreement (Agreement), whereby the Equipment Owner has leased to the Carrier
certain motor vehicle equipment listed below, owned and controlled by the Equipment Owner, whereby the
Equipment Owner is providing the Carrier as operator or operators of the Equipment for the purpose of loading,
transporting and unloading freight.
II.
The Original Agreement is on file at the Carrier’s General Office. A copy of this Lease Agreement and receipt for
the Equipment must be carried on the Equipment as required by 49 CFR §376. Carrier verifies that the Equipment
is being operated by the Carrier, pursuant to the terms of the Agreement.
III.
Equipment Owner/Equipment Information
Name:___________________________________
Phone #: _______________________________________
dba: ____________________________________
Contact: ________________________________________
Address: _________________________________
FEIN: __________________________________________
_________________________________
Year: _______ Make: ____________________ VIN: ________________________________ Unit #: __________
IV.
Duration of Lease Agreement and Termination
The Lease Agreement shall begin on the date below and shall remain in effect until terminated by either party, giv-
ing notice to that effect. Notice may be given personally, by mail or by fax at the address or fax number shown in
the Lease Agreement.
MOTOR CARRIER/REGISTRANT
EQUIPMENT OWNER
By: ____________________________________________
By: ____________________________________________
Date: __________________________________________
Date: __________________________________________
MC #:__________________________________________
USDOT #: ______________________________________
Printed by authority of the State of Illinois. November 2011 — 1 — VSD 683.2
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