Form Page: phx03

Equipment Financial Services

Section 1: Applicant Information

Guarantor 1

Guarantor 2

Years in Business (yrs.mon)

Section 2: Guarantor(s)

Approximate Cost

Section 3: Equipment, Cost & Terms Requested

I/we hereby authorize you to whom this application is made and your agents and assigns to investigate my\our personal & company credit worthiness including
but not limited to the obtaining of personal consumer credit report(s).

My/our typed name(s) followed by four digits of my/our selection typed herebelow constitutes my/our electronic signature aurthorizing you to conduct any investigation you deem necessary to approve this application for lease.

Date of Signing

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income devices from any public assistance program; 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 concerning this creditor is the Federal Trade Commission, Division of Credit Practices, 6th Street and Pennsylvania Avenue, NW, Washington, DC 20580.

Date of Signing

Section 4: Notes to us and YOUR AUTHORIZATION: Please read carefully: