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By submitting this form, you hereby certify, represent and warrant to Banesco USA, that: You are organized, existing and in good standing under the laws of the State that the business is incorporated in. You are duly qualified and licensed in each state in which you are doing business within the meaning of the relevant state laws relating to licensing or qualifications of foreign companies and referral agents. In addition, you hereby authorize Banesco USA, or any of its affiliates to make all inquiries it deems necessary to verify the accuracy of the information provided herein, which includes obtaining a business credit report regarding you or any entity that you are affiliated with. Furthermore, you hereby certify that the enclosed information, including all attachments, is valid, accurate, and complete. By submitting this form, you consent to receive communications from Banesco USA, including information, updates, and offers related to our products and services. You may withdraw your consent at any time by following the unsubscribe instructions included in any email or by contacting Banesco USA directly. By typing my name below I certify that I am the individual named, an owner of the business, and am authorized to submit this form on behalf of the business. I agree that typing my name will serve as my signature to this form.
