Leasing & Finance 1. Lessee Company Information Company Name Company Address City Zip Company Phone FAX Number E-mail Years in Business Business ClassificationSole ProprietorshipPartnershipC. CorpS. CorpLLCLLPNon-Profit 2. Principals Information Name (Principal #1) Home Address City Zip Home Phone Number Title/PositionOwner (Sole Prop)General PartnerPartnerManaging Member (LLC)Member (LLC)President (Corp.)Secretary (Corp.)CEO (Corp.)CFO (Corp.)COO (Corp.)VP (Corp.) % Ownership Name (Principal #2) Home Address City Zip Home Phone Number Title/PositionNoneOwner (Sole Prop)General PartnerPartnerManaging Member (LLC)Member (LLC)President (Corp.)Secretary (Corp.)CEO (Corp.)CFO (Corp.)COO (Corp.)VP (Corp.) % Ownership 4. Proposed Equipment Acquisition Equipment to be Financed Estimated Cost AWIC Quote # 5. Declaration/Authorization This application submitted electronically shall have the same force and effect as if the application bore an inked original signature(s). The above information, together with any accompanying financial statements, schedules, or other materials, is submitted for the purpose of update, renewal, or extension of credit or the collection of any resultant accounts and is warranted to be true, correct, and complete. The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor, or a sole proprietor of the credit applicant, recognizing that his/her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his/her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and shall hold American Walk in Coolers and its assignees harmless from same. You understand that such investigation may include seeking information as to the background, credit, and financial responsibility of your officers and principals (or any of them). A photocopy, fax, or an electronic reproduction of this authorization shall be valid as the original. By entering your name below, you accept and agree to the terms and conditions above. By entering your name below, you accept and agree to the terms and conditions above. Name (Electronic Signature) Date In accordance with the USA Patriot Act, Federal law requires all financial institutions to obtain, verify, and record information that identifies each individual or entity opening an account. This includes all personal and commercial accounts including loan and deposit accounts, as well as trust, brokerage, insurance and investment management accounts. When you apply for credit, you will be asked for your name, address, social security or tax identification number, date of birth (if applicable) and other information that will allow American Walk in Coolers to identify you. You may also be asked to furnish your driver's license or other identifying documents. 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 or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial.