Financing

EASY CREDIT APPLICATION
Company Name *
Address *
City *	State * Zip *
Phone *	Email Address
Years in Business	Federal ID#
Sole Proprietorship Partnership Corporation LLC
PRINCIPALS
Name/Title
Social Security No.
Home Address
Name/Title
Social Security No.
Home Address
Equipment to be financed	Price *
The above certifies they are applying for business purposes only and authorizes Intech Funding Corp. or its assignee to investigate all information contained herein and accompanying this application. The above authorizes and requests all parties to release any information requested concerning personal or business credit standing.

Note: The credit application information you are about to submit is secure.