Oklahoma Assistive Technology Foundation
APPLICATION CERTIFICATION and AUTHORIZATION

word document

The undersigned, being duly authorized agent(s) and principal(s) of the proposed Borrower, ______________________________, collectively referred to as "Applicant" request that this application be accepted for review of a guaranty loan by the OkAT Board of Directors.  Applicant hereby acknowledges that the "Application" includes, OkAT Monthly Expense Sheet, OkAT Loan Application Report and the information previously or subsequently provided to BancFirst of Stillwater, Oklahoma ABLE Tech and/or the Oklahoma Assistive Technology Foundation (OkAT).  The Applicant certifies that the Application is accurate and complete.  The applicant authorizes OkAT to verify the accuracy of the information.  Applicant understands that any material misstatement or misleading statement herein is cause for denial or rescission of any approval or assistance received in connection with this Application.  Applicant understands that OkAT will retain this Application whether or not Applicant’s loan request is approved.  Applicant agrees to notify OkAT, in writing, of any change in name, address, phone number or employment.  Initials:    

Applicant understands that issuance of a loan does not imply any type of warranty by either OkAT or BancFirst of Stillwater on the devise or equipment purchased with loan proceeds.  Therefore, Applicant can make no claims against either OkAT or BancFirst of Stillwater for any defects in the device or equipment, or any accident or injury resulting from its use.

Initials:

The applicant understands a condition of guaranty loan is to have the monthly payment electronically transferred from an account with a financial institution.  If the applicant does not currently have an account with a financial institution, you understand and agree to open an account with a financial institution for the electronic transfer of funds as a condition for receiving a loan from this program.  Initials: ________

This loan is for the purpose of purchasing assistive technology or equipment for a telework outcome.  The loan can not be used to refinance a previous purchase.  Initials: ________

Because OkAT guarantees Applicant’s loan from BancFirst of Stillwater, should Applicant default on the loan, and OkAT makes a payment on Applicant’s behalf, either partial or in full, Applicant understands that Applicant is obligated to repay that amount of money to OkAT.  Initials: ________

Name: (Please Print)                                                                             Date:                           

Signature: