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verify any information provided to Palm Beach National Bank & Trust Company on this Application on any such required document. including inquires to the Internal Revenue Service, business credit reporting arid credit bureau agencies and associations, and further authorizes Palm Beach National Bank & Trust Company, its hailing

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ble to verify any Wcimation provided to Pain Beach NlillOnSI Bonk & Trust Company on Via Appication on any such ranged document. racketing Wig**, to the Internal Revenue Service, busmen craft reponing and Credit bureau agencies end associations. end we authorise Palm Beach National Bank & Trust Company, Its holding company e

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erify any inforntation provided to Palm Beach National Bank & Trust Company on this Application on any such required document, including inquires to the Internal Revenue Service, business credit reporting and credit bureau agencies end associations, and further authorizes Palm Beach National Dank & Trust Company, its holding

FEES PAID LOAN IN CASH FINANCE PROCEED OTHER: LOAN FEE !!:..PDC STAMPS ZINTANGIBLE TAX ilc•IEN FEES 1-!CC FILINGS ;:;CITEREST fic.,THER: SIGNERS & TITLE: • CHECK # ACCT // WIRE OTHER: .AYMENT METHOD: COUPON BILLING _X_ AUTO CHARGE ;:;)AN DATE: TED FIRST PAYMENT DATE: Standard • DATE DOCUMENT

to venfy any information provided to Palm Beach Manorial Bank & Trust Conpany on this Application on any such required doewain including inmates to the Internal Revenue Service, busmen credit reporting and credit bureau agencies and assottalsourg, and further authorizes Palm Beach National Bank & Truce Conesay, a muting tOr

S 54,533 S 113,800 FEES PAID LOAN IN CASH FINANCE PROCEED OTHER: ()AN FEE •:)C STAMPS (TANGIBLE TAX !EN FEES :CC FILINGS mTEREST ,THER: SIGNERS & TITLE: CHECK/ ACCT WIRE OTHER: 'NYMENT METHOD: COUPON "AN DATE: TBD FIRST PAYMENT DATE: Standard Case No. clkitp7315-CV-MARRA P-o0 I OD) BILLING