Business Legal Name:*

Legal Entity Type:*

DBA(Doing Business As):*

How much capital is being requested $:*

Physical Address:*

What is the capital being requested for?*

Mailling Address:*

Website and/or Social Media address:*

Business Start Date:* Seasonal Y/N:*

PRINCIPAL-1st OWNER

PRINCIPAL-2nd OWNER

Industry(SIC Code or Describe):

Rented Or Owned:

Rent/Mortgage Amount:

Current Dredit Card Processor:

Annual Sales (Previous Year's Tax Retrun):

Open Bankuptcy/Judgements/Tax Liens?

FUNDING INFORMATION

Total Monthly Sales(All Forms of Revenue):*:

List the total Visa/Mastercard processing volumes for the previous four months:

Last Month

Two Months Ago

Three Months Ago

Four Months Ago

TRADE REFERENCE

TRADE REFERENCE CONTECT
PHONE

Upload Document (Required *)

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 Federal Direct Funding LLC including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Federal Direct Funding LLC of any change in such information or financial condition, (3) Applicant authorizes Federal Direct Funding LLCtodiscloseallinformation and documents that Federal Direct Funding LLC 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 Merchant Cash Advance 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) each Assignee will rely upon the accuracy and completeness of such information and documents, (5) , Federal Direct Funding LLC 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 sign this form on behalf of Merchant.

Owner Signature:

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Print Name:
Date:

Owner Signature:

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Print Name:
Date: