Servicing Application

Name
Address
Mailing Address (If different from Merchant address)
Merchant Owner (print name)
Managers/Key Personnel (print name)
Interest Rate

% - If non taxable, put 0% (please contact us tax rate changes)
(Please list the bank account in which you will receive your monthly deposits)
(Please list the bank account in which you will receive your monthly deposits)
Signature
Name
Address