Customer Application

Personal Information – Please complete information for all Principals / Officers / Guarantors

Company Bank Reference – Please provide current three months of business bank statements

Loan References – Please attach copies of recent monthly payment statements for each account

Equipment Vendor Information – Please attach copies of equipment quotes, proposals or invoices

Summary of Request – provide cost of equipment and business summary

Declaration

I hereby authorize the release of business and/or personal credit information to First US Finance, its affiliates or assignees (1) from any source including credit bureau reporting agencies and my bank for the purpose of extending credit, (2) and to any credit reporting agency. Additionally I hereby authorize the release of my application without notice, to any other non-related potential lending sources for consideration of approval of credit. I hereby represent all information is true, correct and complete. A photo static and/or facsimile copy of this authorization shall be valid as the original.

USA Patriot Act Notification

The following notification is being provided to you pursuant to Part 326 of the USA Patriot Act of 2001, 31 CFR 103.121(b)(5): IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT - To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, including any deposit account, loan, lease, or extension of credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

For files larger than 2mb please email to: Sales@FirstUSFinance.com