Financing Application - Vending Concepts

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Business Information

Legal Company Name*

Doing Business As (DBA)

Business Type*

Industry*

Business Start Date*

Annual Revenue

EIN (Tax Id)*

State of Incorporation

Business Address*

Street Address Address Line 2 City State ZIP Code

County*

Primary Contact E-mail

Primary Contact E-mail (Confirm)

Business Phone Number*

Ext.

Website

Requested Amount*

Equipment Description

Owner Information

Name*

First Last

Birth Date*

Social Security Number*

Driver License Number*

State Issued

Email*

Email (Confirm)*

Owner Percentage*

Home Phone Number*

Work Phone Number

Ext.

Mobile Phone Number

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Type

Own
Rent

Electronic Signature*

I hereby confirm that the Applicant, Co-Applicant and proposed guarantor(s) provided herein (1) are aware of the VENDING CONCEPTS, LLC's request for financing; (2) may be required to guaranty the requested financing; and (3) have authorized ClickLease LLC to obtain their respective consumer credit report (collectively the "Credit Consent").

By clicking this box, I authorize ClickLease LLC, and its assigns, on behalf of the Applicant, Co-Applicant and any proposed guarantor(s) provided herein (collectively the "Authorizing Parties"): (1) to obtain a personal consumer credit report on each of the Authorizing Parties, (2) authorize the release to ClickLease LLC of all credit and other information ClickLease LLC may request related to the Authorizing Parties; and (3) confirm that each of the Authorizing Parties has provided his/her Credit Consent.*

I agree.