Credit Application

Questions? Call Ric Rivett at (800) 553-9208 or find us online @ www.intechfunding.com

Required fields are marked with an asterisk *

General Distributing Co.


Company Name*

Phone*

Email Address

Street Address

City

County

State

ZIP Code

Federal Tax ID

Tax Filing Type

State of Incorporation

# Years in Business

Annual Sales ($)

Equipment Location

Principals

1. Principal Name

Title

% Ownership

Social Security #

Birth Date

Home Street Address

City

State

ZIP Code

Home Phone

Purpose

Equipment to be Financed*

Seller

Price*

Signature

The undersigned certifies they are applying for business purposes only, and authorizes and certifies that each individual named on this application authorizes Intech Funding Corp., or its designee(s), agent(s), affiliate(s), other lenders, or its assignee(s) ("Intech"), to investigate all information contained herein and accompanying this application, and to request and obtain commercial and consumer credit reports on the business and each individual. The undersigned authorizes and requests all parties to release any information requested concerning personal or business credit standing. This application in its entirety, including all authorizations and certifications, shall apply to any future request for financing from Intech, and such authorizations and certifications shall be deemed repeated at such time.