BusinessIQ

General Information

Application Amount
$

Credit Limit Requested
$

Existing / Previous Account #

Trade Reference Information

Reference Name

Reference Type

Reference Account Number

Reference Account Type

Reference Account Balance
$

Phone Number

Reference Email

Contact Name

Phone Number

Contact Email

Reference Name

Reference Type

Reference Account Number

Reference Account Type

Reference Account Balance
$

Phone Number

Reference Email

Contact Name

Phone Number

Contact Email

Reference Name

Reference Type

Reference Account Number

Reference Account Type

Reference Account Balance
$

Phone Number

Reference Email

Contact Name

Phone Number

Contact Email

Bank Reference Information

Bank Name

Bank Account Number

Bank Account Type

Bank Address

Bank City

Bank State/Province

Bank Zip/Postal

Bank Country

Bank Contact Name

Bank Contact Phone Number

Bank Contact Email Address

PERSONAL INFORMATION OFFICERS, OWNERS, GUARANTORS

^*Principal Type

^*Principal First Name

Principal Middle Name

^*Principal Last Name

^*Principal Home Address

^*City

^*State/ Province

^*Zip/Postal

Telephone - Home

Telephone - Work

Principal Email Address

^*Principal Social Security Number (SSN)

^*Personal Guarantee Authorization (Y/N)
Yes No

Principal Type

Principal First Name

Principal Middle Name

Principal Last Name

Principal Home Address

City

State/ Province

Zip/Postal

Telephone - Home

Telephone - Work

Principal Email Address

Principal Social Security Number (SSN)

Personal Guarantee

In consideration, I/we hereby unconditionally guarantee all monies owed, the obligation of the undersigned shall be a continuing guaranty and not be terminated or changed in any aspect not withstanding any circumstances or occurrence whatsoever which otherwise might terminate or change the obligation of the Applicant. I/we shall be personally obligated and liable hereon regardless of the inclusion hereunder of a corporate name or office. I/we also agree that its liability under this guaranty shall be primary, and that in any right of action which shall occur, ClearSpan at its option may proceed against without having commenced any action against or having obtained any judgment against borrower. ClearSpan shall not, by any act or omission, be deemed to waive any of its rights, remedies or powers hereunder or otherwise, unless such waiver is in writing and signed by the ClearSpan. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and ClearSpan.

PRINT AGREEMENT

^*Signature Of Guarantor

^*Title

^*Date

The Guarantor(s) execute(s) this Guarantee on his or her own personal behalf, and not in any other capacity regardless of how Guarantor may characterize itself and agrees to all Terms and Conditions of this Application in its entirety.

BY SIGNING ABOVE THE INDIVIDUAL IS EXECUTING THIS AUTHORIZATION FOR CREDIT REPORT INDIVIDUALLY FOR THE PURPOSE OF AUTHORIZING CLEARSPAN TO OBTAIN A CONSUMER CREDIT REPORT FROM TIME TO TIME ON THE UNDERSIGNED INDIVIDUAL THROUGH CREDIT AND CONSUMER REPORTING AGENCIES OR OTHER SOURCES, IN ORDER TO FURTHER EVALUATE THE CREDITWORTHINESS OF SUCH INDIVIDUAL IN CONNECTION WITH THE CREDIT EVALUATION PROCESS AND THE PROPOSED EXTENSION OF BUSINESS CREDIT TO THE APPLICANT. THE UNDERSIGNED, AS AN INDIVIDUAL, HEREBY KNOWINGLY CONSENTS TO THE USE OF SUCH CREDIT REPORT IN ACCORDANCE WITH THE FEDERAL FAIR CREDIT REPORTING ACT AS CONTAINED IN 15 U.S.C 1681 SEQ. AS AMENDED FROM TIME TO TIME.

Attachments

If the applicant is tax exempt, upload the following document. Please Note, regardless of your tax exempt status, we reserve the right to ask the Applicant and Owner(s) for additional identification documents. Our Staff will contact you directly if needed.

Attachment Description

Attachment Location

Terms and Conditions

^*Signature of Applicant

^*Title

^*Date

PRINT AGREEMENT

I agree to the terms and conditions specified above.

User Verification

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