The Applicant(s) represent that all information provided within this Application is true and correct and hereby authorizes Third-party financing companies or its assignee to obtain from other entities, information it deems necessary to arrive at the decision regarding this application.

By submitting this Application, the Applicant(s) as principal of and/or guarantor(s), authorizes third-party entities, its’ designees, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering this Application and for update, renewal, or extension of credit to the Applicant(s) or the collection of any resultant accounts. The Applicant(s) authorizes all deposit, borrowing, financial and trade information to be released to the third-party financing company by telephone or fax. An online submission, e-mail, photocopy or facsimile of this authorization shall be valid as the original.

Disclaimer: Takara Belmont USA does not provide financing. The submitted information will be transmitted to an unaffiliated, third-party financing company.