Company Information ________________________________________________________

Address* City* State* Zip*

Phone Fax E-mail Contact*

Time in business under current ownership* Years Months

Business Type Corporation LLC Proprietorship - Project Type New business Additional location Relocation Expansion/Remodel -

Personal Information - This is for officers, partners, or guarantors ________________________________

Home address* City* State* Zip* Home Phone*

Name* Title * Social Security # * Ownership % *

Home address* City* State* Zip* Home Phone*

Name* Title * Social Security # * Ownership % *

Home address* City* State* Zip* Home Phone*

Name* Title * Social Security # * Ownership % *

Home address* City* State* Zip* Home Phone*

Bank Information ___________________________________________________________

Contact Phone E-mail

Authorization for Release of Financial Information ___________________________________________________________________

The undersigned represents that all information provided with this application is true and correct and hereby authorizes Beneficial Capital Leasing (BCL) to obtain from third parties, information it deems necessary to arrive at a decision regarding this application. To help fight terrorism and money laundering, the information you provide will be verified. By signing below, the undersigned individual(s) as principal of and/or guarantor for the applicant, authorizes BCL, its designees, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering this application and for the purpose of update, renewal, or extension credit to the applicant or the collection of any result accounts. The undersigned authorizes all deposits, borrowing, financial and trade information to be released to BCL by telephone or fax. A photocopy of facsimile of this authorization shall be valid as the original.

I agree with all information listed above. Please accept this as my signature