NL FINANCIAL SERVICES            CREDIT APPLICATION
RR # 2  Box 589,  Sugarloaf PA  18249         Phone:  570-384-4878      Fax:  570-384-2556
Applicant Information
Business Name           Phone          
                         
Trade Name   Fax  
                         
Street Address   Years in Business  
                         
City, State, Zip   Nature of Business  
                         
Contact Fed ID #   Corp., Prop., Partnership, etc.  
                         
Personal Information -- Officers, Owners.
Name   Home Address     Home Phone   SS #   Title  
                         
Name   Home Address   Home Phone   SS#   Title  
                         
Vendor Equipment Information
            Cost            
Mickey's Truck & Equipment Sales, Inc.              
    Description  
RR #2,  Box 509                      
     
Sugarloaf,  PA  18249                
Phone Fax   Vin #  
888-340-1756   570-384-2556              
Contact   Requested Term   Requested Purchase Option
Neil Leonard                      
Banking Information  (Minimum 2 years Business Banking)
Bank Name       Account Number   Phone     Contact  
                         
Trade References  (Minimum 2 year history)
Trade Name       Account Number Phone     Contact  
                         
Trade Name   Account Number Phone   Contact  
                         
Trade Name   Account Number Phone   Contact  
                         
Credit References  (Business Credit - Finance Co., Banks)
Name         Account Number Phone     Contact  
                         
Name   Account Number Phone   Contact  
                         
I hereby authorize you or your agents to investigate my/our credit worthiness and will provide financial statements, tax returns, etc., as you deem necessary
I/we agree that any security deposit paid is not refundable unless the application is rejected.  By the execution of any lease/loan agreement I/we warrant
that the information submitted herein is true and correct and hereby authorize references contained herein to release any necessary information.  Further,
I/we warrant that it is understood that Creditor reserves the right to reverse any credit decision if the information contained herein is found to be incorrect,
or any reason, and I/we will indemnify Creditor for any and all cost incurred with this application for credit, and any cost incurred in the placement or reservation
of the intended equipment based on the information contained herein.
Signiture:                 Date:  
X                        
Signiture:   Date:  
X