13605 S.

CLACKAMAS RIVER DRIVE, OREGON CITY, OR 97045 INDIVIDUAL OR FIRM NAME STREET ADDRESS CITY

LEGACY FINANCE GROUP, LLC

Application
DATE STATE ZIP TELEPHONE Bus TELEPHONE Cell TELEPHONE - FAX

ADDRESS OR CHIEF PLACE OF BUSINESS OR MAILING ADDRESS IF OTHER THAN ABOVE TYPE OF BUSINESS Fed Tax ID: SOLE OWNER PRINCIPAL OR OFFICER TIME IN BUSINESS

PARTNERSHIP S.S. NUMBER TITLE

CORPORATION

LLC

HOME ADDRESS

BANK NAME BUSINESS

ACCOUNT NUMBER

TELEPHONE

BANK CONTACT

TRADE REFERENCES

ADDRESS

TELEPHONE

LANDLORD VENDOR ADDRESS TYPE OF EQUIPMENT LEASE TERMS DESIRED TELEPHONE NUMBER CONTACT TOTAL COST $

The undersigned individual/s as principal of and/or guarantor for the applicant provides written consent to Legacy Finance Group, LLC and /or assigns or potential assigns authorizing review of his or her Personal Credit profile from a National Credit Bureau and review of bank account and Trade information now and from time to time as may be needed in the credit evaluation and review process and waives any right or claim they would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent. A Fax or Photocopy of this Authorization shall be as valid as the Original.

Applicants Signature

Date

Co-Applicants Signature

Date

Brian Schwindt Phone: 503-805-3211 / legacy nancegroupbs@gmail.com Fax: 503 -650-7963