COMPANY INFORMATION

OFFICERS, PARTNERS, OR GUARANTORS

Please include an attachment for any additional personal guarantors (or for anyone with 10% or more ownership).

EQUIPMENT INFORMATION

DECLARATION / AUTHORIZATION

By signing below, each of the above-listed Business Owner(s)/Officer(s)/Principal(s) and Business (individually and collectively, "You") certify that all information and documents submitted in connection with this Funding Application ("Application") are accurate, true, correct and complete; and that You will immediately notify Access Capital or any of its representatives, successors, assigns, designees, agents, partners or affiliates (individually and collectively, "Recipients") of any change in such information or financial condition. You further authorize Access Capital and/or Recipients to obtain consumer or personal, business and investigative reports, references and other information about You, including, but not limited to 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, financial institutions, creditors and other third parties, now or in the future. You also authorize Access Capital to transmit this Application, along with any of the foregoing information obtained in connection with this Application, to any or all of the Recipients for the foregoing purposes. You agree to adopt this typed electronic representation of your name as your signature and shall be valid as the original. You consent and agree to receive updates from Access Capital and/or assignees regarding this account via the telephone or fax numbers or email address provided in connection with this or any future application.

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