Apply — Hage Financial

BRIGADOON FITNESS COMMERCIAL SALES
1818 Research Drive, Fort Wayne, IN 46808
Phone 800.269.7130 | Fax 800.813.1102
info@brigadoonfitness.com | www.brigadoonfitness.com

business information

asterisk denotes required fields.

Complete legal name of business and D/B/A name (if any)

State of incorporation

Business phone

(###)

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Business fax

(###)

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Contact person

First Name

Last Name

Cell phone

(###)

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Email address (contact)

Years under current ownership

Federal tax ID number

Business address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

principal/owner information

Principal 1: name

First Name

Last Name

Principal 1: cell phone

(###)

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Principal 1: % of ownership

Principal 1: title

Principal 1: alt phone

(###)

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Principal 1: social security #

Principal 1: home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Principal 2: name

First Name

Last Name

Principal 2: cell phone

(###)

###

####

Principal 2: % of ownership

Principal 2: title

Principal 2: alt phone

(###)

###

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Principal 2: social security #

Principal 2: home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Principal 3: name

First Name

Last Name

Principal 3: cell phone

(###)

###

####

Principal 3: % of ownership

Principal 3: title

Principal 3: alt phone

(###)

###

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Principal 3: social security #

Principal 3: home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Principal 4: name

First Name

Last Name

Principal 4: cell phone

(###)

###

####

Principal 4: % of ownership

Principal 4: title

Principal 4: alt phone

(###)

###

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Principal 4: social security #

Principal 4: home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

equipment information

Cost of equipment (approx)

Condition of equipment

New

Used

Desired terms/months

Vendor name

Vendor phone

(###)

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Equipment description

Terms of applications

By signing below, the undersigned individual(s), who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction and authority to Hage Financial Services, Inc. or its designee as well as and in addition to any assignee or potential signee thereof authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purpose of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photo static or facsimile copy of this authorization shall be valid as the original.

Electronic signature