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*First Name:

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*Company Name:

Company Type: Company Type:Limited CompanyLimited Liability PartnershipPartnership (4 or more partners)Partnership (less than 4 partners)Sole Trader

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Number of Years Trading: Number of Years Trading:Not started yetLess than 1 year1 to 3 years3 years plus

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Amount Required: Amount Required:10,00020,00030,00040,00050,00060,00070,00080,00090,000100,000110,000120,000130,000140,000150,000160,000170,000180,000190,000200,000

Term of Agreement required Term of Agreement required6 months1 year18 months2 years3 years4 years5 yearsother

Credit History: Credit History:ExcellentGoodFairPoor