Funding Application

A. Business Information
B. Ownership
C. Lease
D. Trade Suppliers
E. Business Profile
F. Cash Advance
G. Other Information
Highest Volume Months:
H. Signature

By signing below, the Merchant and its owners/principals: (1) certify that all information on and documents submitted in connection with this Application are true, correct, and complete; and (2) authorize RetailCapital, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties, in order to verify any information provided on the Application.

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