10. A AXIS ALL Master PRE-QUALIFICATION FORM

Axis All Application
Company Information
Business Legal Name*
Business DBA Name*
Business "Doing Business As"
Type of Business Entity (check one)*

CorporationLTD PartnershipLLCPartnershipSole ProprietorLLP
Industry Type:*
Describe
Business Start Date*

MonthDayYear
Date
State of Incorporation*
Use of Proceeds*
What will you use the funds for?
Amount Requested*
Enter Dollar Amount
Physical Location Phone Number*
Federal Tax ID*
Enter EIN
Business Website Address
If you do not have a website, please type "NONE"
Physical Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Current Advanced/ Loans?
Current Lending Information
Owner Information
Full Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number.
Email Address*
example@example.com
% of Ownership*
Social Security Number*
Enter SSN
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Additional Owner?*
Owner 2 Information
Full Name

First NameLast Name
Job Title
% of Ownership
Social Security Number
Enter SSN
Date of Birth

MonthDayYear
Date
Mobile Number
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
AUTHORIZATIONS
By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Axis All 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 about you, 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. You also authorize Axis to transmit this application form, along with any of the foregoing information obtainin connection with this application, to any or all of the Recipients for the forgoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Axis and to each of the Recipients, on it's own behalf." Owner(s) and business ("you") understand that if this business credit request is approved, your payment obligations can be made through ACH debits by lender / purchaser or its designee to initiate an ACH test debit from the bank account designated below to confirm that if this credit request is approved, payment processing will proceed as agreed. The test debit will be in a random but in no event more than $1.00.
Owner Print name*
Signature of Owner*

Clear
Date*

MonthDayYear
Date
Owner 2 Print Name
Signature of Owner 2

Clear
Date

MonthDayYear
Date
Please upload the last 4 months of your business bank statements.

Cancelof
Should be Empty:

AUTHORIZATIONS