The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each

represents, acknowledges and agrees that

(1) all information and documents provided to

Representative including business bank and/or credit card processor statements are true, accurate and complete,

(2) Applicant will immediately notify Representative of any change in such information or financial

condition,

(3) Applicant authorizes Representative to disclose all information and documents that

Representative may obtain including credit reports to other persons or entities (collectively,

“Assignees”) that may be involved with or acquire commercial loans having daily repayment features

or purchases of future receivables including ChargeToday transactions, including without

limitation the application therefor (collectively, “Transactions”), and each Assignee is authorized

to use such information and documents, and share such information and documents with other

Assignees, in connection with potential Transactions,

(4) Representative and each Assignee will

rely upon the accuracy and completeness of such information and documents,

(5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively,

“Recipients”) are authorized to request and receive any investigative reports, credit reports,

statements from creditors or financial institutions, verification of information, or any other

information that a Recipient deems necessary,

(6) Applicant waives and releases any claims against

Recipients and any information‐providers arising from any act or omission relating to the

requesting, receiving or release of information, and

(7) each Owner/Officer represents that he or

she is authorized to submit this form on behalf of Merchant. A copy of this authorization may be

accepted as an original. A copy of this authorization may be accepted as an original. The term

“Representative” shall mean any funding source looking to offer, make available, or provide to the

Merchant access to loans or merchant cash advances based on such Merchant’s future receivables or

sales and/or structured with a periodic repayment feature. By clicking submit you agree to these terms.