FireWolf - Revolutionary Marketing

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RAPID RELIEF APPLICANT INFORMATION

All Fields Required [If unable to answer any question, please enter NA]

Date :
Applicant Name :
Applicant Cell Phone Number :
Business Legal Name :
Trade Name or DBA(if applicable) :
Business Address (street, city, state, zip) :
Mailing Address (if different) :
Business Phone Number :
Business Fax Number :
Business Email Address :
Business Website URL :
Tax ID Number :
Legal Structure :
Corporate Subchapter :
Non-Profit Corporation Type :
Organized in the State Of :
SIC Code (or industry category) :
How long under current ownership? :
Number of Employees :
Annual Sales :
What Product/Service your sell? :
How long in business? :
Principals and % Ownership :
 
BANKING & FINANCIAL INFORMATION
 
Bank or Financial Institution :
Contact Name :
Phone No :
 
BUSINESS TRADE CREDITORS/REFERENCES
 
1 .Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 
2 .Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 
3 .Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 
BUSINESS SERVICE PROFESSIONALS
 
Insurance :
Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 
Accountant :
Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 
Attorney :
Name :
Street Address :
City :
State, Zip :
Contact :
Phone No. :
 


GENERAL CONDITIONS

Authorization. Each party signing this application (each a "Signer" and together the "Signers") authorizes FireWolf, Inc. (the "Agency") to obtain third party reports, and request, verify and review all information that the Agency in its sole discretion deems relevant or otherwise appropriate as to the Applicant or any of its principals, in connection with this application or any future review, update, extension, renewal or modification of any services and discounted pricing extended to the Applicant by the Agency as a result of this application, or in connection with the Agency's collection efforts relating to any such service. Each Signer authorizes the Agency to give information about such Signer to any third party requesting such information.

Certification. Each Signer certifies that the information provided in this application is true and correct as of the date specified beside such Signer's signature below. Each Signer acknowledges that any misrepresentation, whether intentional or negligent, in this application may result in civil liabilities, as well as liability for monetary damages to the Agency and to all agents, assigns and insurers of the Agency, and any others, who or that suffer any loss or damages as a result of any such misrepresentation.

Continuing Statement. Each Signer will notify the Agency immediately if there is any material change in any of the information given in this application as to such Signer or in any financial statement regarding such Signer supplied to induce the Agency to extend the Rapid Relief Business Incentive to the Applicant, whether now or in the future. The Agency may treat this application as a continuing certified statement of the financial condition of each Signer, upon which the Agency may rely in extending any present or future services to the Applicant, except, as to any such future services, to the extent that any such statement is updated in a notice given to the Agency by such Signer before such future service is extended.

Business Name
Principal Name 
Signature
Date

Principal Name 
Signature
Date

Whenever marketing is vital to your future, FireWolf is a solutions provider of choice. Consider the qualities that have established FireWolf as the leader in revolutionary marketing and join a world of satisfied clients. Call 1-888-FIREWOLF today for more information.

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