The undersigned acknowledge(s) that this signed application, submitted for the purpose of obtaining credit from CH Brown Co., is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/We will give prompt written notice of any subsequent substantial change in such financial condition occurring before discharge of this obligation to you. I/We understand that you will retain this application whether or not you approve the credit in connection with which is submitted. You are authorized to check any credit or employment history or any other information herein.
Any willful misrepresentation on this statement could result in a fine and/or imprisonment under provisions of the U.S. criminal code.