LCA Business Funding Application

I am applying for business funding (owning 51% of applying business) soley in my name and am relying on my own income or assets and not the income or assets of another person as the basis for repayment.(Complete Owner Information (1) and omit Owner Information (2)

1

We are applying for a joint business funding with one or more people (total combined ownership equals 51% of applying business (Complete Owner Information (1) and as many additional owners till 51% ownership is reached)

2

Date*

Date

Intended Use of Funds:*

Funding Requested: $*

Legal Company Name:*

State of Incorporation:*

Tax ID:*

Doing Business As (DBA)

Physical Address:*

City/State:*

Zip Code:*

Company Phone:*

Business Inception Date:*

Date

Location:*

Rent LocationOwn Location

Monthly Rent/Mortgage:*

Legal Entity:*

Company Type / Industry:*

Annual Business Revenue:*

Monthly Credit Card Volume (If Applicable)

Average Bank Balance:*

Any Business with an Open MCA?*

YesNo

Landlord Name

Landlord Phone

First Name:*

Last Name:*

Home Address:*

City/State:*

Zip Code:*

Home Phone:

Cell Phone:*

% Ownership:*

Social Security No:*

Date of Birth:*

Date

E-mail Address:*

example@example.com

Annual Income:

Name:

First NameLast Name

Home Address:

City/State:

Zip Code:

Home Phone:

Cell Phone:

% Ownership:

Social Security No:

Date of Birth:

Date

E mail Address:

example@example.com

Annual Income:

The Merchant and Owner(syofficer(s)identified above (individually, an "Applicant") each represents, acknowledges and agrees that (1) all information and documents provided to Leonard Capital Advance ("Company") including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Company of any change in such information or financial condition, (3) Applicant authorizes Company to disclose all information and documents that Company 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 therefore (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) Company, 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 ( Each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.

Signature (1)*

Signature (2)

Date (1)*

Date

Date (2)

Date

Owner Information (1)

Owner Information (2) (If Applicable)

Financial Information: