Vantage Equities Source Application

Are you currently working with a Vantage Equities Source Agent?*

YesNo

Agent Name*

Amount Requested*

Use of Funds*

Federal Tax ID # *

Business Legal Name: *

Business D/B/A Name:*

Industry Type*

Type of Entity *

State Incorporated*

Annual Revenue*

Business Start Date*

Date

Business Phone #*

Please enter a valid phone number.

Business Address: *

Street Address

Street Address Line 2

CityState

Zip Code

Home Based Business*

YesNo

Does the Business accept Credit Cards?*

YesNo

How Many Owners?*

12

Current Business Advances/Loans?*

YesNo

Name*

First NameLast Name

Cell Phone # *

SSN: *

Business Ownership %:*

Date of Birth*

Date

Home Address *

Street Address

Street Address Line 2

CityState

Zip Code

Email*

example@example.com

Do you own or rent your home?*

OwnRent

I accept and acknowledge that I have chosen to utilize an electronic signature for the purposes of submitting an application for working capital. This electronic signature is intended by all the parties to be treated the same as an ink signature, and all parties may rely on this electronic signature as if it is an ink signature and I agree to the terms & conditions.

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 Vantage Equities Source, INC. (“VE”) are true, accurate, and complete, (2) Applicant will immediately notify VE of any change in such financial condition, (3) Applicant waives and releases any claims against VE, Recipients, and any information-providers arising from any act or omission relating to the requesting, receiving, or release of information, (4) each Applicant represents that he or she is authorized to sign this form on behalf of Merchant, (5) the  Applicant agrees to receive calls, texts, emails or mail from VE or Recipients, (6) Applicant authorizes VE to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes, and (7) Applicant consents to the release, by any creditor or financial institution, of any information relating to Applicant, to VE and to each of the Recipients, on its own behalf. Furthermore, Applicant hereby waives and releases any claims against VE, all 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. This authorization shall be valid for one hundred twenty (120) days unless revoked in writing by Applicant.&#13;&#10;&#13;&#10;Terms of Use for Text Message (SMS)&#13;&#10;(1)Your wireless carrier’s standard messaging rates apply to SMS correspondence, Vantage Equities Source, does not charge for any content; however, you may incur additional charges from your wireless carrier. Please contact your wireless carrier for information about your messaging plan. Your carrier may impose message or charge limitations on your account that are outside of our control. All charges are billed by and payable to your wireless carrier. (2)You represent that you are the owner, or authorized user of the wireless device you use to receive the service, and that you are authorized to approve the applicable charges. (3)We will send you messages periodically, and only with your explicit agreement as indicated by your continuation of the process flow. (4)We will not be liable for any delays or failures in your receipt of any SMS messages as delivery is subject to effective transmission from your network operator and processing by your mobile device. SMS message services are provided on an AS IS, AS AVAILABLE basis. (5)Data obtained from you in connection with this SMS service may include your mobile phone number, your carrier’s name, and the date, time and content of your messages and other information that you may provide. We may use this information to contact you and to provide the services you request from us, discuss your advance, current and past due payments and to otherwise operate, develop and improve the service. Your wireless carrier and other service providers may also collect data from your SMS usage, and their practices are governed by their own policies. We will only use the information you provide to the service to transmit your text message or as otherwise described in this terms and conditions. Nonetheless, we reserve the right to all times to disclose any information as necessary to satisfy any law, regulation, or governmental request, to avoid liability, or to protect our rights or property. When you complete forms online or otherwise provide us information in connection with the service, you agree to provide accurate, complete and true information. (6)The service as well as the content and materials received through the service are proprietary to us and our licensors and is for your personal and commercial use only. You shall not damage, impair, interfere with, or disrupt the service or its functionality. (7)We reserve the right to alter charges and/or these terms and conditions from time to time. We may suspend or terminate the service to you if we believe you are in breach of our terms and conditions. Your service is also subject to termination in the event your wireless service terminates or lapses. We may discontinue the service at any time. (8)Additionally, you agree that we any send any SMS Statement Notifications through your communication service provider in order to deliver them to you. You agree to provide a valid mobile phone number for these services. You further agree to indemnify, defend, and hold us harmless from and against any and all claims, losses, liability, cost and expenses (including reasonable attorneys’ fee) arising from your provision of a mobile phone number that is not your own or your violation of applicable federal, state or local law, regulation or ordinance. Your obligation under this paragraph shall survive termination of the agreement. SMS Statement Notification is provided for your convenience only. (9)If you have any questions, e-mail Vantage Equities Source (10)We do not charge for help or info messages; however, your normal carrier rates apply. (11)To Opt Out Text STOP to cancel.&#13;&#10;Protection of Information&#13;&#10;Each Merchant and each person signing this Application on behalf of each Merchant and/or as Owner, in respect of himself or herself personally, authorizes Straight Line Source to disclose information concerning each Merchant, Owner and/or Guarantor’s credit standing and business conduct to agents, affiliates, subsidiaries, and credit reporting bureaus. Each Merchant, Guarantor, and Owner hereby waives to the maximum extent permitted by law any claim for damages against Vantage Equities Source or any of its affiliates relating to any (i) investigation undertaken by or on behalf of Vantage Equities Source as permitted by this Application or (ii) disclosure of information as permitted by this Application.&#13;&#10;Confidentiality&#13;&#10;Each Merchant understands and agrees that the terms and conditions of the products and services offered by Vantage Equities Source, including this Application and any other Vantage Equities Source documents (collectively, “Confidential Information”) are proprietary and confidential information of Vantage Equities Source. Accordingly, unless disclosure is required by law or court order, Merchant(s) shall not disclose Confidential Information of Vantage Equities Source to any person other than an attorney, accountant, financial advisor, or employee of any Merchant who needs to know such information for the purpose of advising any Merchant (“Advisor”), provided such Advisor uses such information solely for the purpose of advising any Merchant.

File Documents*

Signature *

Vantage Equities Source Application

Business Information

Owner Information