BRENNER FINANCIAL, INC. CREDIT APPLICATION 2222 PAXTON STREET HARRISBURG, PA 17111 MAILING ADDRESS: P.O. BOX 1955, HARRISBURG, PA 17105 Phone: (717) 238-5820 Fax: (717) 238-5848
BUSINESS APPLICANT (ATTACH CURRENT FINANCIAL STATEMENT)

BUSINESS NAME
ADDRESS       STREET       CITY       STATE       ZIP
PHONE       DATE ESTABLISHED       DATE PRESENT OWNERSHIP COMMENCED
FAX #     CELL #       E-MAIL       WEBSITE
COUNTY WHERE EQUIP IS LOCATED	Prop       Corp       Partnership       LLC
NATURE OF BUSINESS
PRINCIPALS NAME     POSITION     % OF OWNERSHIP
PRINCIPALS NAME     POSITION     % OF OWNERSHIP
PRINCIPALS NAME     POSITION     % OF OWNERSHIP
PRINCIPALS NAME     POSITION     % OF OWNERSHIP

BANK REFERENCE

NAME OF BANK       PHONE

PERSON TO CONTACT       CHECKING ACCOUNT #       LOAN ACCOUNT #

TRADE REFERENCES

NAME OF COMPANY       PHONE
NAME OF COMPANY       PHONE
CURRENT LEASE OBLIGATION	NAME OF COMPANY OR BANK	PHONE	ACCOUNT #
YES     NO

INSURANCE REFERENCE

NAME OF INSURANCE AGENT       PHONE

ADDRESS       STREET       CITY       STATE       ZIP

QUANTITY	TERM	N - NEW U - USED	EQUIPMENT TO BE LEASED	PRICE

By submitting this application, I/We further expressly warrant that I/we have no other debts than those reffered to herein. You are hereby authorized to obtain any information that you require concerning the statements in this application, which shall remain your property whether or not the loan is granted. In this connection, I/we authorize Brenner Financial, Inc. or any credit bureau, credit reporting agency, or any investigative agency employed by any of the foregoing, to investigate or cause to be investigated an of the data contained herein or any other data obtained from me/us or from any other person pertaining to my/our credit and financial responsibility. I/we further agree to promptly notify you of any changes in the information set forth in this application.

Yes, I agree to the disclaimer above.

No, I disagree with the disclaimer above and wish to exit this application.

INDIVIDUAL APPLICANT

LAST NAME     FIRST NAME     M.I.     SS#

ADDRESS     CITY     STATE     ZIP

OWN RENT   HOW LONG   HOME PHONE   CELL PHONE   E-MAIL ADDRESS

NAME AND ADDRESS OF MORTGAGE CO.    PHONE     MORTGAGE NUMBER

MONTHLY PAYMENT PURCHASE PRICE ORIGINAL MORTGAGE DATED BALANCE DUE

PRESENT VALUE     TITLED IN NAME OF

PREVIOUS ADDRESS

EMPLOYEERS NAME AND ADDRESS

HOW LONG     BUSINESS PHONE

OCCUPATION     SALARY

BANK ACCOUNT WITH     CHECKING     SAVINGS     IN WHOSE NAME

OUTSTANDING OBLIGATIONS AND / OR CREDIT REFRENCES

NAME	ADDRESS	BALANCE DUE	PAYMENT

JOINT APPLICANT

LAST NAME     FIRST NAME     M.I.     SS#

ADDRESS     CITY     STATE     ZIP

OWN RENT   HOW LONG   HOME PHONE   CELL PHONE   E-MAIL ADDRESS

NAME AND ADDRESS OF MORTGAGE CO.    PHONE     MORTGAGE NUMBER

MONTHLY PAYMENT PURCHASE PRICE ORIGINAL MORTGAGE DATED BALANCE DUE

PRESENT VALUE     TITLED IN NAME OF

PREVIOUS ADDRESS

EMPLOYEERS NAME AND ADDRESS

HOW LONG     BUSINESS PHONE

OCCUPATION     SALARY

BANK ACCOUNT WITH     CHECKING     SAVINGS     IN WHOSE NAME

OUTSTANDING OBLIGATIONS AND / OR CREDIT REFRENCES

NAME	ADDRESS	BALANCE DUE	PAYMENT

By submitting this application I/we authorize Brenner Financial, Inc. or any credit bureau, credit reporting agency, or any investigative agency employed by any of the foregoing, to investigate or cause to be investigated any of the data contained herein or any other data obtained from me/us or from any other person pertaining to my/our credit and financial responsibility. I/we further agree to promptly notify you of any changes in the information set forth in this application.

Yes, I agree to the disclaimer above.

No, I adisagree with the disclaimer above and wish to exit this application.