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Angry Birds Plush Promo

03/22/2012 01:23:31 AM:
Angry Birds FREE SHIPPING Offer Included on most varieties! LOW PRICES!

Perfect Break Systems Finance Online Application

Perfect Break Systems Finance
Online Application

Finance Amount

Amount of Credit Requested: *

Business Information

Current Finance Customer:*

Finance Customer Number:

Type of Business:*

Years in Vending: *

Number of Routes:

Number of Locations:

Number of Machines:

Annual Vending Sales:

First Name:*

Middle Initial*

Last Name:*

Business or DBA Name:*

Business Address Line 1:*

Business Address Line 2:

City:*

State/Province:*

Zip/Postal:*

Country:*

Business Phone:*

Cell Phone/Alternate:*

Business Fax:

Owner/Authorized Signer 1 - First and Last Name: *

Social Security Number:*

Owner/Authorized Signer 2 - First and Last Name:

Social Security Number:

Credit Information

Number of Years at Address:

Occupancy

Same as business address:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip/Postal:

Country:

Home Phone:

Relative First and Last Name:

Relationship

Relative's Phone

Employment Information

Employed Outside of Vending?*

Employer 1:

Salary:

Position:

Years Employed:

Phone:

Employer 2:

Salary:

Position:

Years Employed:

Phone:

Trade References

Company Name:

Phone:

Account Number:

Company Name:

Phone:

Account Number:

Company Name:

Phone:

Account Number:

Equipment

Equipment Interest

Important Notice

Important Notice Please Read:*

For purchases over $ 25,000 we will require the submittal of, 1) last years tax returns and/or 2) current year to date Profit & Loss statement. Please feel free to fax this information to our secure fax line 616-847-0929.

I understand that Wittern Financial Services and Lakeshore Merchandisers International, LLC is relying on this information in extending credit and I warrant it to be true. I hereby authorize Wittern Financial Services or any bank/and or trade bureau or other investigative agencies employed by Wittern Financial Services to investigate the references herein listed or other data obtained from me or any other person pertaining to my credit and financial responsibility. The undersigned authorizes all parties contacted to release credit information requested, or its successors or assigns.

Please indicate your consent to the above terms by clicking on the "I Agree" button below. By providing your consent, you also confirm that you are able to access all of the disclosures, records, and other information provided to you in electronic form. If you have any questions about this notice, please contact us at 1-800-457-5502.

Email Address:*

Confirm Email Address:*

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