All the information on this form is complete, correct and provided to Sthetiqs plastic Surgery Center to obtain an installment loan or credit loan. I/we authorize Sthetiqs plastic Surgery Center to investigate credit and employment history and to report the credit experience of any party or authorized user to consumer reporting agencies and others. I/we understand that Sthetiqs Plastic Surgery Center will retain this application whether or not it is approved. I/we understand that if the application is for a secured loan by real property that additional information is required. I/we certify that I am/we are 18 years or older and have completed the application questions accurately at any time after this application and/or during my/our relationship with Sthetiqs plastic Surgery Center. I/we authorize Sthetiqs Surgery Center to obtain information concerning my/our employment and credit standing and authorize my/our employer, banks and/or other listed references to release information to Sthetiqs plastic Surgery Center. Sthetiqs Surgical Center may review from time to time my/our eligibility for any credit extended on the account and may provide information about me/us to others. If I/we designate other authorized users, credit bureaus may receive account information on the authorized users in each user’s name. I/we agree to notify Sthetiqs plastic Surgery Center immediately upon any material change in the information I/we provided herein.

I/we affirm that each of the answers given to the foregoing questions is true and correct and that the foregoing is a true and correct statement of my/our financial condition. It is a federal criminal offense to knowingly make any false statement or report, or to willfully overvalue any property for the purpose of influencing Sthetiqs plastic surgery Center to act on this application.