Wellness Pro Electrotherapy System

Seal of Safety - Wellness Pro Electrotherapy System Pro

Wellness Pro Electrotherapy System Seal of Approval - Wellness Pro Electrotherapy System

Seal of Approval - Wellness Pro Electrotherapy System

Finance Form

* Items in red are required

Company Information:

Company Legal Name:
Address:
City:
State:
ZIP:
Signor:
Title:
Company Telephone:
Nature of Business:
Number of Years in Business:
Type of business:

Declaration

The information contained on this application, together with any accompanying application, together with any accompanying financial statements, schedules or other materials, is submitted for the purpose of obtaining credit and is warranted to be true, correct and complete. We agree to provide financial statements, tax returns, etc, as Sun State Capital Corp. deems necessary and hereby authorize references contained herein to release any requested information. Sun State Capital Corp. is hereby authorized to investigate (directly or through an agent or nominee) our credit and financial responsibility. We understand that such investigation may include seeking information as to the background, credit and financial responsibility of our officers and principals (or any of them).

Applicant Name:
Title:
Email:
Applicant Phone:
Home address:
City:
State:
ZIP:
Partnership percentage:
Date:

COMPANY BANK REFERENCE

Name of Bank Branch:
How long:
Telephone:
Contact officer:

EQUIPMENT INFORMATION

Type of equipment:
Equipment Cost:
Lease Terms:

Notes / Comments: