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Personal Information

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Address 2

Apt.

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Financial Information

Present Occupation*

Annual Income*

Approximate Net Worth*

Available Cash on Hand*

Geographic Area of Interest*

How soon are you going into business*

Release Authorization

I (we) hereby authorized One Price Inc. to submit to potential funding sources and their agents my (ours) Social Security Number for the purpose of verifying any credit information from whatever source deemed appropriate including, but not limited to, credit reporting bureaus. I (we) further authorize our banks, trades, reference and financial institutions to release by mail, email or facsimile all credit information that is requested.
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