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Ation ). I also grant any such creditors permission to release Information to Creditor and/or Dealer. I authorize Creditor to disclose Information to any of its affiliates, assigns or agents. Total Cost of Equipment Down Payment Amount to Finance Terms (in years) Frequency (choose one): Annual Equipment Delivery Date Remittance (choose one): Advance Semi-Annual Quarterly Monthly Arrears Applicable Signature Title Date ****** COMPLETION OF THIS DOCUMENT IS NOT A BINDING COMMITMENT.

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