Integrated Machinery, Inc.
Credit Application

  First Name  M.I.  Last Name  SS# / SIN#  Birth Date | MM/DD/YY
  First Name  M.I.  Last Name  SS# / SIN#  Birth Date | MM/DD/YY
  Business Name  Tax ID# / GST#
  Presidents First Name  M.I.  Last  SS# / SIN#  Birth date | MM/DD/YY
  Street Address  Mailing Address
  City  State / Province  Zip / Postal Code
  Home Phone Business Phone  Business Type  Years in Business

  Income Frequency    Income Amount $  Annual Expenses $
  Main Lending Reference  Contact  Phone Number
  Other Lending Reference  Contact  Phone Number
  Checking Account             Savings Account      Bank  Phone Number
Have I/we had any unsatisfied judgments rendered against me/us in the past 7 years, had equipment repossessed in the past 7 years, or been declared bankrupt in the past 10 years?
Please explain below for any yes answer.

I/we understand and agree that you may assign or transfer this credit application and may also communicate the information contained herein to others to decide whether or not to extend credit. I/we authorize the bank and business references, as well as any of my/our lessors, landlords and any other past or present creditors to give any and all necessary information to you, your assignees or transferees, which will assist you in your credit inquiry. This application is given for the purpose of obtaining credit. I/We hereby  certify under penalty of law that the foregoing is a true and complete statement of my/our financial condition. In the event of any material change in my/our financial condition, I/We will notify you immediately in writing.
  Customers Signature  Date | MM/DD/YY


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