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FinanciaLogic, Inc
Credit Application


ABOUT SSL CERTIFICATES

1. Customer:
Company (legal name) DBA:
Physical Address: County:
City: State: Zip:
Central Phone Number: Fax Number:
Contact Person: Phone Number:
Title Email Address:

2. Customer Credit Information
Describe Business:
Date Started: Incorporation Date: Incorporation State:
Business Type:
Who Owns What Percentage: Federal Tax ID:
Parent Corporation: Webpage:

3. Personal Information on Officers, Partners or Guarantors:
Legal Full Name: Goes by:
Home Address: Home Phone:
City: State: Zip:
Relationship (Title) to Customer: SS Number:
Signature: Date:
Legal Full Name: Goes by:
Home Address: Home Phone:
City: State: Zip:
Relationship (Title) to Customer: SS Number:
Signature: Date:

4. Bank & Trade Sheet - (Please provide or complete Bank & Trade Sheet form)

Equipment Location:
Physical Address: County:
City: State: Zip:

6. Vendor Information:
Vendor: Salesperson:
System(s) Description:
Amount to Finance: Lease Term Desired:
Estimated Payments: Anticipated Acceptance Date of All Items:

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