Business Details

Application Details

Co-Applicant Details

Financial Information

Equipment to be Leased / Financed

Additional Comments

The undersigned certifies the above information and any information provided in the application and or Appendix A to be true and correct. Appendix A refers to any information provided, collected and or attached to complete this application. By signing below, I consent and authorize Global Wholesale Machinery and its Lenders and representatives, at any time to obtain on an on-going basis, verify, use, communicate with and disclose to third parties (including credit reporting agencies, credit exchanges, lenders, leasing brokers, and credit grantors, on an on-going basis) any of my credit, financial, and personal information that Quip deems necessary to complete, service or enforce any lease, ancillary deed or transaction, including but not limited to assignments and securitizations. You authorize us to collect, hold, exchange and disclose your personal information as requested in order to administer your contract & determine your insurance eligibility as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. If you would like to review your own personal information, correct or revise existing information, have any questions, concerns or comments regarding its application please email marketing@globalwholesalemachinery.com (Attn: Privacy Office) or mail 2808 5TH ST., NISKU, AB Attn: Privacy Office.

Signature