CREDIT APPLICATION – Americus Credit Group

Business Information

BUSINESS DETAILS

Company Name
DBA
Fed Tax ID
Business Start Date
Company Type
Bankruptcy

Annual Revenue
Company Type

ADDRESS

Email
Country
State/Province
City
Street
Postal Code

Primary Contact

CONTACT DETAILS

Title
First Name
Last Name
Phone
Email

Additional Guarantors

GUARANTOR 1

Title
First Name
Last Name
Home Phone
Email
Social Security Number
Date of Birth
Country
State/Province
City
Street
ADDRESS

GUARANTOR 2

Title
First Name
Last Name
Home Phone
Email
Social Security Number
Date of Birth
Country
State/Province
City
Street
ADDRESS

Equipment

EQUIPMENT 1

Description
Cost Per Unit
Quantity
Equipment Condition

EQUIPMENT 2

Description
Cost Per Unit
Quantity
Equipment Condition

Credit Authorization

I authorize

I hereby certify that the information contained in this credit application is true and accurate and I hereby authorize ACG, its partners, and lenders to obtain consumer credit reports relating to individual credit history and/or creditworthiness and any other information regarding Commercial Applicant and its owners and principals from third parties to verify any information provided on the Application. I hereby authorize the filing and recording of UCC financing statements showing the Lender’s interest in all the business assets and grant ACG the right to execute them in our company name or by the representative. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for update, renewal, or extension of such credit or additional credit and for reviewing or collecting the resulting account. I/we affirm my/our identity as the respective individual(s) identified in this application.