Comvest, Ltd., Inc.

LOAN/LEASE APPLICATION

COMVEST Ltd., Inc. LEASE APPLICATION

BORROWER/LESSEE
PRINCIPAL'S NAME
PHONE NUMBER
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FEIN #
ADDRESS
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NAME & TITLE OF OFFICER SIGNING LEASE

EQUIPMENT
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COMVEST Ltd., Inc., will be requesting information by telephone on all accounts maintained with you. Please accept this release as authorization to provide the requested information.
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Date (MM/DD/YYYY)