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Ownership Information

Primary Owner

Owner #2

Owner #3

Equipment Information

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By submitting this form, the undersigned individual as principal of and/or guarantor for the applicant, authorizes XQ Equipment, its financing partners, designees, assigns or potential assigns to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of the update, renewal or extension of credit to the applicant or the collection of any resultant accounts. The undersigned acknowledges and consents that their information, including personal credit profile, may be submitted on their behalf to a third-party financing partner in connection with this application. Permission is hereby granted to correspond with either party via facsimile, email, verbal or any common means of delivery. A fax, email or photocopy of this authorization shall be valid as the original.

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