The information obtained on this form is for the purpose of applying for a loan. It is not sold and shared with any other party other than the banks who will provide the service. Your information is encrypted using an SSL certificate to safeguard your information.

Vendor Name: Yankee Tech Digital LLC

Equipment Description. Brand name and model if available *

Finance Amount *

Finance amount including equipment, computers, training, and additional parts

Requested Finance Terms *

How many months? Available terms are Thirty-Six, Forty-Eight, and Sixty months

Business Information:

Business Name:

DBA:

Doing Business As

Years in Business: *

Type of Business: *

Business Address:

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone: *

Fax Number:

Organization ID Number:

Are you licensed? *

Yes
No

Type of License:

License Number:

State:

Contact Name:

First

Last

Contact Phone:

Email *

Website / URL

Guarantor Information

Guarantor Name:

First

Last

Social Security *

Guarantor Address:

Address Line 1

Address Line 2

City

State

Zip Code

File Upload

Click or drag a file to this area to upload.

Use to upload relevant information

By signing below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to TIAA BANK. or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau and permission to obtain a reference from the above referenced Bank. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A Photostat or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individuals identified in the above application.

Date: *

Name *

First

Last

Title: *

Signature

Disclousure

For security purposes and to help the government fight terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each individual or commercial entity that enters into a customer relationship with the financial institution. For this reason we may request the following identifying information: name, address, date of birth. We may also ask other questions or request documents meant to verify your individual or commercial identity. Equal Credit Opportunity Act (“ECOA”) Notice Note: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact our ECOA Compliance Representative at TIAA Bank Commercial Finance, Inc., 10 Waterview Blvd, Parsippany, NJ 07054, 866- 550-8795, within 60 days from the date you are notified of your denial. Within 30 days of receiving your request we will send you a written statement specifying the reasons for the denial. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning the creditor is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3450, Houston, TX 77010–9050.

TIAA BANK

Agent Name: MARTY FITZGERALD

973-576-0631 Office & Cell

Voice 847-363-8795

Cell for Texting & Voice 408-323-3719 Fax

eMail:marty.fitzgerald@tiaabank.com

Credit Application - Healthcare V6 07212011