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Client Application

Please complete the form.

Client Application

Is this application for Medical Spa Equipment and/or Medical Spa Services?
Yes
No
Title
Mr.
Mrs.
Ms.
Rather Not Say
Birthday
Month
Day
Year

123456789 - No Dashes

Multi-line address
Date Started Living at This Address
Month
Day
Year

When you moved in to this address.

If you own the company, type Self-Employed.

Gross Income (Before Taxes)

Company Multi-line address
Date Started
Month
Day
Year

When you started with this company.

By signing below, you authorize Business Consulting Services to obtain a consumer credit report and/or other background information about you from a credit reporting agency for the purpose of evaluating your application for financing, leasing, tenancy, employment, or other business transaction.


You understand that this inquiry may include information regarding your credit history, creditworthiness, payment history, and other information from consumer reporting agencies.


This authorization is limited to the purposes stated above and does not authorize the release of your information for any other reason.

You further acknowledge and agree that:


  1. This authorization does not guarantee approval of your application.


  2. The information obtained will be used solely for evaluating your eligibility.


  3. You have the right, under the Fair Credit Reporting Act (FCRA), to request a copy of any credit report obtained and to dispute any inaccurate or incomplete information.

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