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  • Practice Name

    Important to list legal name of entitiy
  • Phone Number
  • ( If different than above )
  • Equipment / Software To Be Financed

  • Vendor Contact
  • Personal Information

    On Officers, Partners, or Guarantors
  • Authorization to Release Information

  • By submitting this form, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, or is authorized to sign on behalf of the applicant ,provides written instruction to GSG Capital, LLC or its designee (any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau and obtain bank and trade references. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat, facsimile or emailed copy of this authorization shall be valid as the original. This Authorization is continuing for future extensions of credit and extends to lending sources to whom we submit this application and potential funding, and from whom GSG Capital may request and obtain documents and information for credit review and potential funding. By submitting below, I/we affirm my/our identity as the respective individual’s identified in the above application.
  • This field is for validation purposes and should be left unchanged.
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