Midwest Integrated Solutions
2626 Midwest Court
Champaign, Illinois 61822

(217) 819-3097 Office
(217) 819-3109 Fax
(800) 313-5324 Toll Free
http://www.midwestintegrated.com Web Site
info@midwestintegrated.com E-Mail

Capital Leasing Information, available upon request

Name:

Company Name:

Company Address:

Person to contact on site:

Phone Number:

Nature of Service Request: