Applicant Agreement and Signature

I certify that the information I have given on this form is correct. I am applying for a loan from the Seller to purchase a chattel as described in the Seller's bill of sale The Seller will be referring this application to a Financial Institution because the Seller intends to assign this loan to the Financial Institution, if my loan is approved. This loan is a separate transaction from the purchase; my obligation to make loan payments will not be affected by any dispute that may arise between me and the Seller.

THE SELLER AND THE FINANCIAL INSTITUTION MAY FROM TIME TO TIME GIVE ANY CREDIT AND OTHER INFORMATION ABOUT ME, INCLUDING ANY INFORMATION ON THIS FORM, TO, OR RECEIVED SUCH INFORMATION FROM: (A) ANY CREDIT BUREAU OR REPORTING AGENCY; (B) ANY PERSON WITH WHOM I HAVE OR PURPOSE TO HAVE FINANCIAL DEALINGS; AND (C) ANY PERSON IN CONNECTION WITH ANY DEALINGS I HAVE OR PROPOSE TO HAVE WITH THE DEALER OR FINANCIAL INSTITUTION.

I agree that the Financial Institution may use that information to establish and maintain my relationship with it and to offer me any services as permitted by law.

If there is a 'Buyer' and 'Co-Buyer', all references on this document to 'I', 'me' and 'my' apply to both.

Financing Form