Application with SummitBase Advisors

Business Legal Name*

Doing Business As

Legal Entity*

EIN Number*

Federal Tax ID

Business Phone*

Company Website (If any)

Cell Phone*

Business Fax

Email Address*

example@example.com

Business Start Date*

Date

State of Incorporation*

Business Address*

Physical Address

Street Address Line 2

CityState

Zip

Full Legal Name Owner 1*

% of Ownership*

Put 100, if you are sole owner of the business

Home Address*

Home Address

Street Address Line 2

CityState

zip

Email Address

example@example.com

Cell Phone

Date of Birth*

Date

Social Security#*

Business Information

RentMortgage/owned

Monthly Rent or Mortgage Payment

2nd Owner I Principal Information (If applicable)

Full Legal Name Owner 2

% of Ownership

Home Address

Street Address Line 2

CityState

zip

Email

example@example.com

Mobile

Date of Birth

Date

Social Security#

When do you want to be funded?

How much Capital is being requested?

What is the Capital being requested for?

Total Monthly Sales (All Forms of Revenue)

By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [AR Capital Group] and each of its representatives, successors, assigns and designees (“Recipients”) 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”) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as Trans Union, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize AR Capital Group to transmit this application form, along with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any s own behalf.

Owner Signature*

Owner Name *

Date

Co-Owner Name

Signature: Co-Owner (If applicable)

Date

Upload last 4 months of Business bank statements. If the request is made after the 10th of the month, include statements up to the current month's date.