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Heath Care Credit Application

Page 1

Business Owner Details















Page 2

Business Details











Bank Details





Page 3

Equipment & Supplier Details













Page 4

Consent

I/We the applicant, principal, and/or guarantor each:

• Consent to the collection, use and disclosure of personal information for the purposes of credit adjudication by the Lessor/Lender and its funders and to enable the Lessor/Lender and its assignees to provide financing and to promote the products and services of the Lessor/Lender and its affiliates; and
• Consent to the Lessor/Lender and its funders obtaining information relating the applicant, principal, and/or guarantor from credit reporting agencies in connection with this application