Applicant Information |
| *Legal Name |
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| *Type of Entity |
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| *Fed Tax Id |
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| *Principal Contact |
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| *Address |
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| *E-Mail |
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| *Phone |
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| Fax |
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Property Information |
| *Year Built |
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| *Number of Rooms |
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| *Premises Owned/Leased |
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| *Property Address |
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| *Phone |
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| Fax |
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| Franchisor Contact |
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| *License Term |
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| *Commenced |
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| *Expires |
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| *Licensee Name |
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Request |
| *Amount Requested |
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| Equipment to be Financed |
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| *Does Applicant or any related entity currently have any outstanding financing arrangements with SFG, LLC for this or any other property? |
yes
no
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| *If Yes, please describe: |
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Signature
Please complete all sections of this application and return all information requested. The application will not be processed until all necessary information has been received. Specialty Finance Group, LLC reserves the right to request additional information at any time during the application processing.
The undersigned applicant hereby represents and warrants that (a) all information furnished to Specialty Finance Group, LLC and its subsidiaries is complete, current, accurate and not misleading; and (b) applicant is solvent, pays its financial obligations in a timely manner and is not subject to any bankruptcy or debt relief proceedings or contemplating filing for such proceedings.
To help the government fight the funding of terrorism and money laundering activities, Federal law requires Specialty Finance Group LLC (“SFG”) to obtain, verify, and record information that identifies each person who opens an account. The information requested includes name, street address, date of birth, and Social Security number. SFG may also ask to see the applicant’s driver’s license or other identifying information.
Applicant authorizes Specialty Finance Group, LLC and its subsidiaries, to investigate and obtain such information, as it deems necessary to consider this application (including, without limitation, credit reports, UCC/judgment reports, and confirmation of account balances and franchise status). Upon request the applicant(s) will be informed of each agency’s name and address. Applicant understands that SFG will retain this application whether or not it is approved. Applicant has read this entire application, agree to its terms, and certify the information is correct.
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| *Applicant Name |
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| *Authorized By |
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| *Title |
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