COMPANY INFORMATION



FINANCING & EQUIPMENT INFORMATION



PRINCIPAL / OWNER INFORMATION



CREDIT INFORMATION



For the purpose of procuring and maintaining credit, the applicant submits the foregoing information as being a full, true and correct statement of financial condition on the date stated. We hereby grant our permission to obtain information from any credit grantor and any of the references provided herein to Concrete Equipment Finance and/or its affiliates.
I hereby authorize Concrete Equipment Finance and any of its representatives or partners to collect, use and disclose my personal information for the purposes of investigating and providing financial services. I have been informed by Concrete Equipment Finance or its partners or representatives, that my personal information is collected, used and disclosed for the follow ing purposes: (1) to collect credit and related financial information from me, from credit agencies, and from any parties listed herein, (2) to use the information collected to determine my financial situation, to provide financial services I have requested and to offer additional products and services of Concrete Equipment Finance that may be of benefit to me, (3) to share the information with assignees, bankers or funding partners of Concrete Equipment Finance, (4) to share the information collected and any information on my commercial dealings with Concrete Equipment Finance with credit agencies or other financial institutions. Further, I specifically acknowledge that Concrete Equipment Finance may assign this agreement and any related agreements in whole or in part from time to time and I agree that any personal information collected in relation to this agreement may be made available to any such proposed assignee.”