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Credit Application
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" indicates required fields
Company Name
*
Phone Number
*
Time in Business
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Street Address
*
Street Address
City, State, & Zip Code
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Street Address
Equipment Cost
*
Supplier or Vendor
Vendor Phone Number
Equipment or Software Description
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Owner 1 - Name
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Phone Number
*
Email
*
Street Address
*
Street Address
City, State,& Zip Code
*
Street Address
SSN
*
Percent Ownership
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Owner 2 - Name (If Applicable)
Phone Number
Email
Street Address
Street Address
City, State,& Zip Code
Street Address
SSN
Percent Ownership
I certify that all the above information is true and correct and hereby authorize all of my credit and haul/employment references to release any information requested. I hereby authorize H&M Financial Corp and/or its assignees to verify any and all credit information, including, but not limited to banks, trade and credit reports. Additionally, I understand that by clicking on the I AGREE button immediately above this notice, I am providing “written instructions” to H&M Financial Corp under the Fair Credit Reporting Act authorizing H&M Financial Corp to obtain information from my personal credit profile or other information from MicroBilt. I authorize H&M Financial Corp to obtain such information solely to prequalify me for credit options. Credit Information accessed for my pre-qualification request may be different than the Credit Information accessed by a credit grantor on a date after the date of my original pre-qualification request to make the credit decision.
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I Agree and Authorize
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I certify that all the above information is true and correct and hereby authorize all of my credit and haul/employment references to release any information requested. I hereby authorize H&M Financial Corp and/or its assignees to verify any and all credit information, including, but not limited to banks, trade and credit reports.
Additionally, I understand that by clicking on the I AGREE button immediately above this notice, I am providing “written instructions” to H&M Financial Corp under the Fair Credit Reporting Act authorizing H&M Financial Corp to obtain information from my personal credit profile or other information from MicroBilt. I authorize H&M Financial Corp to obtain such information solely to prequalify me for credit options. Credit Information accessed for my pre-qualification request may be different than the Credit Information accessed by a credit grantor on a date after the date of my original pre-qualification request to make the credit decision.
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