By signing below, each of the above listed business and business owner/officer (individually and collectively, "Applicant") certify that the Applicant is an owner of the above-named business and that all information provided in the application is true and accurate. Applicant shall immediately notify United Capital and Merchant Services LLC of any change in such information or financial condition. Applicant authorizes United Capital and Merchant Services LLC to share this application with each of its representatives, successors, assigns and designees ("Assignees") or any other parties that may be involved with the extension of credit pursuant to this application including those who offer commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, "Transactions"). Applicant further authorizes United Capital and Merchant Services LLC and all Assignees to request and receive any third party consumer or personal, business and investigative reports and other information about Applicant, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian, and Equifax, and from other credit bureaus, banks, creditors and other third parties. Applicant authorizes United Capital and Merchant Services LLC to transmit this form, along with any other foregoing information obtained in connection with this application, to any or all of the Assignees for the foregoing purpose. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to United Capital and Merchant Services LLC and to each of the Assignees, on its own behalf. 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 the information obtained in connection with this application.