BUSINESS STRUCTURES:
Proprietorship Partnership S-Corp LLC LLP

Ownership:
Principal's Name: Title: % Ownership:
Home Address: City:
State: Zip: Home Ph:
SS#: -- Email Address:
Annual Salary: Est. Net Worth:
Principal's Name: Title: % Ownership:
Home Address: City:
State: Zip: Home Ph:
SS#: - - Email Address:
Annual Salary: Est. Net Worth:

BANKS:
Bank Name: Phone:
Account Number: Account Under Name Of:
Date Opened: Contact Name:
Bank Name: Phone:
Account Number: Account Under Name Of:
Date Opened: Contact Name:

TRADES:
Company Name: Account #:
Ph: Contact:
Company Name: Account #:
Ph: Contact:
Company Name: Account #:
Ph: Contact:

EQUIPMENT:
Vendor Name: Address:
Phone: Contact:                                      Please enter approximate date  
Equipment Description: Expected Delivery Date:
Location of Equipment (if other than above address):
County Location of Equipment:
Cost of Equipment: Requested Terms:
Equip: New Used Preferred Buyout: $1.00 10% FMV
Rep: Referred By::
Authorization: By entering my/our name, address and social security number herein, the so-described individual(s), who are is either a principal of the credit applicant or a guarantor of its obligations, provides written instruction to ML Financial Services, Inc. or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau and/or from any bank or trade reference provided herein. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. By completing the aforementioned application, I/we affirm my/our identity as the respective individual(s) identified in this Electronic Application.