Royalty Factoring Profile Form

How did you find out about TMI & Partners, Ltd? *

Name*

First NameLast Name

Company*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Office Phone*

Cell Number*

Website*

E-mail*

Do you have a copy of your royalty agreement?*

YesNo

Business Type*

What year did you start and incorporated your business?*

Do you have a U.S valid ID or passport?*

YesNo

Do you have the latest royalty report or accounting statement?*

YesNo

At present, are your royalties assigned or shared with another party?*

YesNo

How long have you been receiving royalty payments? *

What is the best time to call your office?*

Directions: Upon receipt of Diagnostic Profile Form and payment, TMI will reach out to the client within 24 hours. Please have all supporting documents.*

Yes

The Business Owner(s) identified above (individually, an" Applicant “) each represents, acknowledges and agrees that (1) all information and documents provided to TMI & PARTNERS are true, accurate and complete,(2) Applicant will immediately notify TMI & PARTNERS of any change in such information or financial condition, (3) Applicant authorizes TMI & PARTNERS to disclose all information and documents that TMI & PARTNERS maintains, including credit reports and personal information and any information that Applicant may provide to TMI & PARTNERS in Applicants’ Application(s) for any TMI & PARTNERS product, service or programs, to other persons or entities(collectively, “Assignees”), as follows;(a) to Assignees that may be involved with or acquire commercial loans having daily, weekly, bi- weekly or monthly repayment features,(b) to Assignee that may be involved with purchases of future receivables including merchant cash advance transactions, and(c) to Assignees for the purpose of offering applicant of products, services or programs for those of third parties that TMI & PARTNERS believes Applicant may find of interest, including, without limitation, equipment financing and /or equipment leasing programs and alternative financing programs/lines of credit and services (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) Assignee will rely upon the accuracy and completeness of such information and documents,(5) TMI & PARTNERS, Assignees, and each of their representatives, successors, As signs 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 waves and releases any and all claims against Recipients and any information providers arising from any act or omission relating to the requesting, receiving or release of information and(7) each Applicant represents that he and/or she is authorized to sign this form on behalf of the Business Owner (s),(8) Applicant agrees that TMI & PARTNERS or its agents or representatives may contact applicant via telephone( including landline, or mobile phone), text message or email (including without limitation adding you to our mailing list campaigns, newsletter), using information which is publicly available or which Applicant or its agents, employees or representatives have provided to Applicant. By entering the information above, I fully agree*

Yes