Vmax Financing Application

Vmax Fitness Financing Application

Financing Application

Vmax Fitness Financing Application

Complete and submit this form if you wish to use the monthly payment method.

Applicant Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip Code / Postal Code

Country

Phone

Date of Birth

SSN

Driver License Number

Closest Relative (Not living with you)

Phone

Personal References (Not living with you)

Phone

Personal References (Not living with you)

Phone

Current Employer

Phone

How Long

Work Address

Note / Special Instructions / Model Interested

I HEREBY CERTIFY THAT THESE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND ARE MADE FOR THE PURPOSE OF OBTAINING FINANCING FROM ACTIVE GIFTWARE INC, dba VMAX FITNESS.

The applicant hereby authorizes Vmax Fitness and any of its representatives or partners to collect, use and disclose my personal information for the purposes of investigating and providing financial services. The applicant's personal information is collected, used and disclosed for the following purposes: (1) to collect credit report and related financial information from me, from credit agencies, and from any parties listed herein, (2) to use the information collected to determine my financial situation, (3) to share the information with assignees, bankers or funding partners of Vmax Fitness. Further, I specifically acknowledge that Vmax Fitness may assign this agreement and any related agreements in whole or in part from time to time and I agree that any personal information collected in relation to this agreement may be made available to any such proposed assignee, (4) to take collective action if account is outstanding for more than 30 days.#

YOU HAVE MY CONSENT TO OBTAIN MY CREDIT REPORT IN CONNECTION WITH MY APPLICATION FOR CREDIT AND FOR ANY OF THE FOLLOWING PURPOSES: EXTENDING CREDIT TO ME, INCREASING THE CREDIT LINE ON MY ACCOUNT, TAKING COLLECTION ACTION ON THE ACCOUNT, AND OTHER LEGITIMATE PURPOSES ASSOCIATED WITH THE ACCOUNT.