TUS Application- Ryan

Business Name

Federal Tax ID Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Established

MC Number

USDOT Number

Phone Number

Please enter a valid phone number.

Cell Number

Please enter a valid phone number.

Type of Business:

Sole ProprietorCorporationLLCPartnership

Fax

Email

example@example.com

Carrier Authority (Check all that Apply):

CommonContractBrokerageOther

Are you or any Principal currently in a factoring relationship?

YesNo

If yes with whom:

How did you hear about us?

Have you been convicted of a Felony in the last 10 years?

YesNo

Pending Liens/Judgements?

YesNo

Current on all Taxes?

YesNo

Ever File Bankruptcy?

YesNo

Is Company operated out of:

Commercial Office SpaceHome-based

Total Number of Trucks

Type of Freight Hauled

Type of Truck

Type of Trailer

I/We acknowledge that the submission of this factoring application to Treadstone US Capital, LLC (TUS) or any affiliated company does not constitute that we will
approve application nor provide any type of financial services, whatsoever. I/We also hereby acknowledge that approval of this application may only be valid after the
invoices and customers offered are approved in accordance with the terms and conditions of TUS executed factoring and Security Agreement.
(By signing below, I certify that I am either: (a) the owner of the company or, (b) an officer of the Corporation and legally empowered to provide the
information listed for the purpose(s) specified.) I/We hereby certify that all information provided in this application is true and correct and is given to
induce TUS or its assigns to consider entering into a factoring relationship with the applicant(s) at their sole and absolute discretion. I/We hereby
authorize TUS or its assigns to verify and investigate at any time the information provided herein including obtaining a consumer credit report (if
necessary) on all owners or guarantors and any other reports necessary to determine company's eligibility to participate in our program.

Full Legal Name of Owner or Officer #1

Position

Social Security #

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Cell Phone Number

Please enter a valid phone number.

Ownership Percentage

Signature

Date

Full Legal Name of Owner or Officer #2

Position

Social Security #

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Cell Phone Number

Please enter a valid phone number.

Ownership Percentage

Signature

Date