Company Information
(The items in bold are
required fields)
Ownership Information
(The items in bold are
required fields)
Equipment Information
(The items in bold are
required fields)
Terms of Submission (The items in bold are
required fields)
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Business Purposes
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The undersigned
represents that all information provided with this Application is true and correct and hereby authorizes Dick Clark
Associates, Inc. to obtain from third parties information Lessor deems necessary to arrive at a decision regarding
this Application. Applicant certifies to Dick Clark Associates, Inc. that it is applying for credit for business
purposes, and not for personal, family use. |
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Credit Information Release
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The undersigned individual(s), as principal(s) of and/or guarantor(s) for the applicant,
recognizing that his or her individual credit history may be a factor in the evaluation of the credit of the applicant,
hereby consents to and authorizes the above named business credit provider and any assignee, lender or funding
service that may be utilized to obtain and use a consumer credit report on the undersigned, now and from time to
time, as may be needed in the credit evaluation and review process. I (we) specifically consent that this information
may be transmitted via the internet and waive any right or claim I (we) would otherwise have under Fair Credit
Reporting Act in the absence of this continuing consent. Fax, electronic submission, or copy of this authorization
valid as original.
Type your full name here:
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Date:
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By submitting this application I verify that I have read and agreed to the above statements
of "Business Purposes" and "Credit Information Release" and that the information provided is
true. |
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