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Credit Application

Business Legal Name (Merchant):

Business DBA Name:

Address:

City, State, Zip:

Phone:

Fax:

Website:

Email:

Legal Entity:

Federal Tax ID #:

Industry:

Business Start Date: Business Start Date

Business Location:

Products/Services Sold:

Financial Information

How many business do you currently own?

# of Existing Cash Advance?

Average Gross Monthly Sales: $

Have you ever had cash advance judgment?

Is your business a seasonal business? Seasonal Business

Yes

Have you or any of the current owner/s ever filed for bankruptcy? If so, when? What was the conclusion- discharged or dismissed?

Owner Principal Information

Name:

Home Address:

Home City, State, Zip:

Business Address:

Business City, State, Zip:

Home Phone:

Mobile:

Email:

% of Ownership:

Date of Birth:

SSN#:

2nd Principal Information

Name:

Home Address:

Home City, State, Zip:

Business Address:

Business City, State, Zip:

Home Phone:

Mobile:

Email:

% of Ownership:

Date of Birth:

SSN#:

By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted with the Application is true, correct and complete; (2) authorize Chrome Capital Funding and its agents, partners and funder to pull credit reports and any criminal or civil background report and any other information regarding the Merchant and principals directly or from third parties, to verify any information provided on the Application.

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

March 20, 2019 3:00 am EDT

Credit Application Uploaded by Chrome Capital - david@globalsempartners.com IP 107.77.198.82