The fields marked with * are mandatory.
I (we) hereby certify that the information contained in this application
is complete and accurate. This credit information has been furnished
with the understanding that it is to be used to determine the amount of
credit to be established. Furthermore, I (we) hereby authorize the
financial institutions and trade references listed above to release
necessary information to Advanced Commercial Capital, Inc. in order
to verify the information contained herein. Applicant's typed name
attests responsibility and willingness to factor in accordance with
Advanced Commercial Capital's terms.