Highland Capital Corporation

Veterinary Practice Online Quick Credit Application

Step 1: Customer Name:

Step 2: Highland Rep or Vendor Name (if known):

Step 3: Total Amount Financed:

.00

Step 4: Equipment Description:

Step 5: Equip Sales Order:

Step 6: Review and Select Desired Lease Term/Payment

Terms

24 Months

36 Months

48 Months

60 Months

* Approval is subject to credit review.
* Applicable Tax to be added.

Owner 1

Name:

Home address:

E-Mail:

Cellphone:

Social Security:

Date:

Owner 2

Name:

Home address:

E-Mail:

Cellphone:

Social Security:

Date:

Comments

Your Comment:

Optional Documents

Attachment (optional, PDF or JPG):

Contact: Veterinary Account Service, Mail: Veterinary@highlandcc.com, Phone: 1-877-930-4423

AUTHORIZATION:

Acknowledged

AUTHORIZATION: By submitting or signing and faxing the above application, you certify that the information provided in this credit application is accurate and complete and you authorize Highland Capital Corporation, its successors and/or assigns to obtain information from the references listed and obtain a consumer credit report that will be ongoing and relate not only to the evaluation and/or extension of the business credit requested, but also for purposes of reviewing the account, increasing the credit line on the account (if applicable), taking collection action on the account, and for any other legitimate purpose associated with the account as may be needed from time to time. The individual signing or submitting this application further waives any right or claim, which such individual would otherwise have under Fair Credit Reporting Act in the absence of this continuing consent. If more than one person signs above, it is the intent of the abovesigned to apply for joint credit.

ECOA NOTICE (TO BE RETAINED BY APPLICANT):

Your business credit application will be reviewed carefully and a decision will be rendered promptly. If your business credit application is denied, you have the right to a written Statement of the specific reasons for denial. To obtain a statement, please contact us within 60 days from the date that you are notified of our decision. We will send you a written statement of the reasons for denial within 30 days of your request. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, gender, marital status, age (provided 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 our compliance with this law is the Bureau of Consumer Financial Protection, 1700 G Street NW, Washington, DC 20006.