Mobile Groomer Financing


CREDIT AUTHORIZATION


I/We authorize the leasing company to make any necessary credit inquiries deemed proper in connection with this lease application. I/We authorize and instruct any person or consumer-reporting agency to compile and furnish to the Leasing company any information that it may have or obtain in response to such credit inquiries and agree that such information, along with the application, shall remain the leasing company property whether or not the lease is approved.

NOTICE:  THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICANTS ON THE BASIS OF RACE, COLOR, RELIGION, NATURAL ORIGIN, SEX, MARITAL STATUS, OR AGE (PROVIDED THE APPLICANT HAS CAPACITY TO ENTER INTO A BINDING CONTRACT); OR BECAUSE THE APPLICANT HAS IN GOOD FAITH EXERCISED ANY RIGHT UNDER THE CONSUMER CREDIT PROTECTION ACT.  THE FEDERAL AGENCY THAT ADMINISTERS COMPLIANCE WITH THIS LAW IS THE:

FEDERAL TRADE COMMISSION
EQUAL CREDIT OPPORTUNITY
WASHINGTON, D.C. 20580


________________________________________________     _______________________________________________
Applicant Signature                                                        Applicant Signature

____________________________________________________     _______________________________________________
             Printed Name                                                   Printed Name

__________________________________________                    ____________________________________________
Title                         Date                                             Title                         Date

NOTE:  Use full legal name(s).  
Signature(s) must be only those of duly authorized corporate officer, partner, or proprietor, with title indicated.

Applicant’s Name: _______________________________________________________________________________________________

Address: _______________________________________________City: ___________________ State: _________Zip Code: __


Please fax to 203-775-1584

54 Danbury Rd. #213            Ridgefield, CT 06877                    866-611-6360









Mobile Groomer Financing
APPLICATION


Phone: ________________________________________________Email:____________________________________________________________

Fax:_____________________________________________________TAX ID# ________________________________________________

Yrs in business _____________ Please Check:  Corporation 0 Partnership 0 Sole Proprietor 0 Other ___________________________

LOAN TYPE:  
Location ______________________________________________  Amount to be Financed) $_________________ Term _________ (mos).

Description: _____________________________________________________________________________________________________

(Please Attach Invoices or Proposals If Available)

PRINCIPLE OWNERS OR GUARANTORS, PLEASE COMPLETE THE FOLLOWING:

Name ______________________________________________________ Social Security Number _______________________________

Address _________________________________________________________________________________________________________

City, State __________________________________________________________________ Zip_________________________________

Name ______________________________________________________ Social Security Number _______________________________

Address _________________________________________________________________________________________________________

City, State ___________________________________________________________________Zip________________________________

BANK INFORMATION

Bank, Address, City                         Phone #                               Account #                             Contact
____________________________         ______________________         ______________________         ______________________

____________________________         ______________________         ______________________         ______________________
Other Loans or Leases                    Phone #                                Account #                             Contact
____________________________         ______________________         ______________________         ______________________

____________________________         ______________________         ______________________         ______________________
Business Trade References                          Phone #                                            Contact
______________________________________     _________________________________        ___________________________
          
______________________________________     _________________________________        ___________________________  
     
The undersigned certifies that the above information given for the credit purposes is true and correct and authorizes the firm or person to whom this application
is made and any credit bureau or other investigative agency to investigate the references, statement, or other dates listed or accompanying this application.  
The undersigned authorizes all parties contacted to release credit and financial information requested as part of said investigation. All such information shall remain the property of the lender/leasing company whether or not the financing is approved.

SIGNATURE:  ________________________________________________________________________________________________
                                                                                                                                    Title                Date

SIGNATURE:  ________________________________________________________________________________________________
                                                                                                                                    Title                Date
Note: Please use full legal name(s). Signature must be only those of duly authorized corporate officer, partner or proprietor, with title indicated

                Please fax to 203-775-1584

T421        Tim Labus/Joseph Virag