FORM SECURED FINANCE AGREEMENT

SECURED FINANCE AGREEMENT

Customer Name (Exact legal name):

Tax ID #:

ADDRESS / CITY / COUNTY / STATE / ZIP:

Phone:

Fax:

Email:

Equipment Location:

State of Incorporation/Organization:

Vendor:

Address:

Agreement Term (Mos.)

Total Amount Financed

Monthly Payment

Advance Payments

Documentation Fee

Print Name of Signer

Date

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