Form

Commercial Application

Business Information

Business Details

Company Legal Name*

Company Website URL*

Company Industry*

Date Company Established*

Country*

CT Capital only lends within the United States

Fed Tax ID (#########)*

Number of Employees

List related companies with common ownership

Business Street Address*

City*

Company State/Region*

Additional Business Information

Annual Gross Revenue*

Annual Net Income*

Estimate Yards of Concrete Poured/Year*

Yards of concrete poured in the last 12 months*

How do you plan to use the mixer?*

Do you currently use Volumetric?*

Primary Contact Information

Contact Details

First Name*

Last Name*

Job Title*

Phone Number*

🇺🇸

Primary Business Email*

Owner SSN*

Business Owner Details

Are you the Business Owner?*

Ownership %

I (Owner #1) authorize the Terms and Conditions laid out below*

Owner #1 Print Authorization*

Are there Additional Owners?

Yes

Additional Owner(s) Details

Owner 2 - Details

Owner 3 - Details

Owner 4 - Details

Equipment to be Financed

Equipment Being Acquired*

Total Financing Amount Requested

Files

Terms and Conditions for Credit Authorization

Credit Authorization CREDIT DISCLOSURE. For the purpose of obtaining credit, the Contact Person listed above (referred to herein as “you”), on behalf of the Business Applicant listed above (the “Applicant”), hereby authorizes Cemen Tech, Inc., or any of its agents, assignees, designees, affiliates, or non-affiliated third-party business partners (its “Partners”), to check the credit and employment history of the applicant and owners/guarantors, and to otherwise verify the information included in this Application. By submitting this application, you are authorizing the release of credit information to Cemen Tech or its Partners from any source, including credit reporting agencies and the references listed above. You agree that Cemen Tech may provide the information provided in or obtained in connection with this Application to its Partners to use for the purpose of determining eligibility of the Applicant for credit or services requested by completing this Application or for business purposes in providing services that result from this Application. Cemen Tech’s Partners may also use this information when they are considering whether to offer financial or other products or services to the Applicant. CERTIFICATION. By submitting this Application, you hereby certify that the above information is true, complete, and correct to the best of your knowledge and that the person signing on behalf of the Applicant is authorized to do so. You fully understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this extension of credit, as applicable under the provisions of Title 18, U.S. Code, Section 1014. You further certify and agree that the acceptance by Cemen Tech of this Application in no way obligates Cemen Tech to extend or arrange credit for the Applicant. Cemen Tech reserves the right to request additional documentation during the credit review process, including verification of the information provided on the Application, information contained in credit reports, and information at other financial institutions. Cemen Tech may deny the Applicant credit or assistance in obtaining credit for any lawful reason. ACKNOWLEDGEMENT. By submitting this Application, you affirm that, by completing this Application in any capacity, including as the owner of a business entity, a sole proprietor, or a guarantor, even if your personal creditworthiness alone is the basis for establishing eligibility for credit or services sought by this Application, the Applicant is seeking financing to purchase equipment for commercial and/or business purposes only, and not for personal, family, or household use. The authorizations set forth herein apply to this Application and apply subsequently for purposes of updating, renewing, or extending credit and for reviewing or collecting any resulting credit extension. You acknowledge that all credit approvals will be in writing and are subject to the terms and conditions set forth in a credit commitment or other documents. No other terms or oral promises not contained in these written documents may be legally enforced. EQUAL CREDIT OPPORTUNITY ACT DISCLOSURE. The Federal Equal Credit Opportunity act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this company is: FDIC Consumer Response Center, 1100 Walnut Street, Box #11, Kansas City, MO 64106. RIGHT TO REQUEST WRITTEN ADVERSE ACTION NOTICE. If your application for business credit is denied, you have the right to a written statement of specific reasons for the denial. To obtain the statement, please contact us at the following address or telephone number within 60 days from the date you are notified of our decision: Cemen Tech Inc., 1700 N. 14th Street, Indianola, IA 50125, Attn: Credit Servicing Department, Phone (800)-247-2464. We will send you a written statement of reason(s) for the denial within 30 days of receiving the request for the statement. USA PATRIOT ACT DISCLOSURE (CUSTOMER IDENTIFICATION PROGRAM). Important Information About Procedures for Opening A New Account with Cemen Tech, Inc. To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents. In addition, you may be asked several questions, and we may use outside sources to confirm the information. By checking the “I authorize” box, you agree that you have read and understand the above terms, conditions, and disclosures. You certify that you are at least 18 years of age, and a U.S. resident. By clicking Submit, you agree to the above terms, conditions, and disclosures, and intend to submit this Application on behalf of the Business Applicant.*

Cemen Tech is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:

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I agree to allow Cemen Tech to store and process my personal data.*

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