Bobcat Gateway Dealer Network BUSINESS INFORMATION Name/Business Name* Phone Number* Street Address City Zip Nature of Business Date Established County Type of Business CorporationPartnershipProprietorshipLLC Federal I.D. # Email* PRINCIPAL INFORMATION Include all owners to account for 100% of company ownership Primary Owner Legal Name Title ITIN Number/Social Security Date of Birth Phone Number* Street Address City Zip Additional Owner Legal Name Title ITIN Number/Social Security Date of Birth Phone Number Street Address City Zip ADDITIONAL INFORMATION Equipment Type Dealer Location —Please choose an option—EVANSVILLE, IABOWLING GREEN, KYCLARKSVILLE, TNNASHVILLE, TNMCMINNVILLE, TNMAURY COUNTY, TNASHEVILLE, NCSPARTANBURG, SCGREENVILLE, SCCOLUMBIA, SCCHARLESTON, SCCOLUMBIA, MOO'FALLON, MOVALLEY PARK, MOFAIRVIEW HEIGHTS, ILEFFINGHAM, ILSPRINGFIELD, ILCHAMPAIGN, ILMARION, ILLAS VEGAS, NV Your message (optional) By checking below, I/WE hereby authorize Conserv Equipment Leasing, LLC, its heirs & assigns to obtain a personal report on all principals & guarantors for credit purposes, & (2) authorize the release to Conserv Equipment Leasing, LLC of all credit information it may request, including business & personal banking, mortgage, landlord, trade & lease information. Authorized* Name* Title Date