Vendor Name:

American Quality Mfg., Inc/ TanningOnline.com

Estimated Equipment Cost:

Vendor Contact:

Rick Houston

Brief Equipment Description: (please circle)

1 Bed Package    4 Bed Package   7 Bed Package   10 Bed Package

2 Bed Package    5 Bed Package   8 Bed Package   11 Bed Package

3 Bed Package    6 Bed Package   9 Bed Package   12 Bed Package

Vendor Phone:

(888) 999-7577

Vendor Fax:

(866) 237-4208

Full Legal Company Name

Billing Address AND Business Street Address (if different from Billing Address)

City, State, Zip:

Phone:

Type of Business:

Years in Business

Annual Sales

Email Address:

Business Owner’s Name:

Years as Owner

Date of Birth

Social Security Number

Legal Structure (circle one):

LLC                Nonprofit          Sole Proprietor

     Partnership              Corporation

State of Incorporation:

State Organization Number:

Principal I Name:

Principal I Address:

City State Zip:

Principal I Email Address:

Principal I Social Security Number:

Principal I Ownership %:

Principal II Name:

Principal II Address:

City State Zip:

Principal II Email Address:

Principal II Social Security Number:

Principal II Ownership %:

Bank:

Phone #:

Account #:

Contact:

Bank:

Phone #:

Account #:

Contact:

Company Name:

Phone #:

Account #:

Contact:

Company Name:

Phone #:

Account #:

Contact:

Delivery of this application bearing a facsimile signature(s) shall have the same force and effect as if the application bore an inked original signature(s).  The applicant certifies that all information provided is true, correct and complete and that the account will be used solely for business or commercial purposes.  The applicant, owner(s) and guarantor (if any) authorize First Funding or its designee(s) or assignee(s) to obtain any information it may request from any business or consumer reporting agency(ies) or other sources that provide credit reports, account history information, credit and employment history or similar information; such authorization shall extend to update renewal of credit and for reviewing or collecting the account.  The applicant acknowledges that, based upon such information and other factors which may apply, Direct Capital or its assignee(s) or designee(s), in their sole discretion, may either grant or decline to grant credit. By signing below, I also wish to continue to receive updates from First Funding regarding our account. Information should be sent to the fax and/or email address given for the account.

Principal I Signature  _________________________________________________ Date _______________

Principal II Signature _________________________________________________ Date _______________