I hereby represent and warrant that I am duly authorized to provide
this information on behalf of my company. I agree that when I type my name, in the text box
below, that for all intent and purposes I will be providing my legal signature over the
internet to US Financial Group. I further agree that the legal ramifications are the same
as if I actually signed this document in the presence of a US Financial Group representative.
This information is being provided to secure funding for our equipment sales. I grant
permission to US Financial Group to obtain a personal credit report (bureau) on all of the
individuals that are listed above. I understand that individual credit histories may be a
determining factor in the evaluation of this request.
I authorize the bank and business references listed above, as well as any of my/our lessors,
landlords and any other past or present creditors to give any and all necessary information
to US Financial Group, or to their assignees or transferees, which will assist in the
evaluation of this request.
I hereby certify under penalty of law that all of the foregoing information is true.
Please note: Consideration will "not" be given by US Financial
Group unless you have typed your name and title below, which comprises your electronic
signature for internet transmitted documents.