Do you currently have a Cash Advance? If Yes, what is the Current Outstanding Balance?
The Merchant and Owner(s)/Officer(s) identified above [individually, an "Applicant") each represents, cknowledges and agrees that(1) all information and documents provided to Representative including credit card processor statements are true, accurate and complete, (2)Applicant will immediately notify Representative of any change insuchinformation or financial condition, (3) Applicant authorizes Representative to discose al information and documents that Repreventative may obtain including reports to other persons or entities (collectively, "Autignees" that may be involved with or acquire commercial loans having daly regayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitations the application therefor (collectively. Transactions") and each Assignee is use such information and documents, and share such information and documents withother Assignees, in connection with potential (4) Representative and each Assignee will relly upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successon, assigns and designees (collectively, "Recipients") are authorized torequest and receive any investigative of 06 creditfromfinancialverificationinformationotherdeemsand statements creditorsinstitutions,informationRecipientApplicantreleasesclaims reports.reports, ororanythatinecessangwalvesanyagainst Recipients and any information providers arising from any act or omission relating to the requesting receiving of release of information, and(1) exch Owner/Officer represents that he or she is authorized tosignthsform on behalf of Merchant. copy of this authorization nay be accepted as an original The term "Representative" shall mean any funding source looking to offer, make available, or provide to the Merchant access to loans or merchant cash advances based on suchMerchant's future receivables or sales and/or structured with periodk repayment feature.