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Business Address
Business Start Date
Entity Type
Business Location Ownership Type
Where Do You Conduct Your Business?
Do You Currently have Existing Loans?

Please upload your bank statements for the last four months in PDF format.

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Upload your bank statements from the last 4 months here

Agreement

By Signing below, 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 Capital
Funded Group (“CFG”) are true, accurate, and complete,

(2) Applicant will immediately notify CFG of
any change in such financial condition,

(3) CFG and it’s agents and representatives 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 CFG and it’s agents deem
necessary, that may be involved with or acquire commercial loans having daily, weekly, bi weekly or
monthly repayment features of purchase of future receivables included Merchant Cash Advance
transactions

(4) Applicant waives and releases any claims against CFG and any information-providers
arising from any act or omission relating to the requesting, receiving, or release of information,

(5) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant,
and

(6) the Merchant and each Owner/Officers agrees to receive calls, texts, emails or mail from CFG
or its agents.