Application To Get Financing - Class 4 Lasers

GSG Capital - Application To Get Financing
Company Information
Company Name (legal)
Federal Taxpayer Identification Number (TIN)
Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Land Line Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Equipment Address (if different than above)

Street Address

Street Address Line 2

CityState

Zip Code
Number Of Owners With 20% Or More Ownership

Equipment/Software To Be Financed
Description
Class v Laser Therapy Equipment
Vendor Contact Name

First NameLast Name
Amount To Be Financed
Vendor Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Vendor Contact Email
example@example.com

Personal Information (individual # 1)

Officers, Partners, or Guarantors
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security Number (SSN)
% Of Ownership

Personal Information (individual # 2)

Officers, Partners, or Guarantors
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security Number (SSN)
% Of Ownership

Personal Information (individual # 3)

Officers, Partners, or Guarantors
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security Number (SSN)
% Of Ownership

Personal Information (individual # 4)

Officers, Partners, or Guarantors
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security Number (SSN)
% Of Ownership

Authorization To Release Information

By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, or is authorized to sign on behalf of the applicant ,provides written instruction to GSG Capital, LLC or its designee (any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau and obtain bank and trade references. 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, facsimile or emailed copy of this authorization shall be valid as the original. This Authorization is continuing for future extensions of credit and extends to lending sources to whom we submit this application and potential funding, and from whom GSG Capital may request and obtain documents and information for credit review and potential funding. By signature below, I/we affirm my/our identity as the respective individual’s identified in the above application.
Signature
Should be Empty: