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Short Form Merchant Application & Authorization To Review Credit

Merchant Information (Please Complete ALL Information Below Accurately)

Legal Business Name:

Provide legal business name.

D/B/A Name:

Provide doing bussiness as name.

Business Address:

Provide business address.

City:

State:

Zip Code:

Provide business address's zip code.

Business Phone #:

Provide a valid business contact number.

Business Fax #:

Provide a valid business fax number.

Business Email Address:

Provide a valid business contact email address.

Years in Business:

Enter number of years in business.

Business Type:

Provide business type.

Type of Entity:

Est Total Monthly Sales:

What are your estimated total monthly sales.

Est Monthly Credit Card Sales:

Enter estimated monthly credit card sales.

Banking Institution for Business Account(s):

Enter banking instituation name where you have your business account(s).

Has this bank account been open for at least 90 days?
Yes No

Time Remaining On Site Lease/Mortgage:

Enter remaining time on site lease/mortgage.

Nine Digit Federal Tax ID #:

Provide your federal tax id number.

Landlord Name:

Enter the landlord's name.

Landlord Phone #:

Enter landlord's contact number.

Number of Locations:

Enter number of business locations.

If your business for sale?
Yes No

Amount Requested ($):

Enter the requested loan amount.

Have you ever filled for bankruptcy?
Yes No

Intented Use of Money:

What is intended use of money.

Do you have any federal or state tax liens?
Yes No

Name of Authorized Signer:

Type authorized signer name.

Title of Authorized Signer:

Enter authorized signer title.

Principal Owner Information (Please Complete ALL Information Below Accurately)

Are you a US Citizen or Permanent Resident?
Yes No

Ownership %:

What is the ownsership perentage.

Score:

Enter credit score.

Principal Owner Name:

Enter principal owner's name.

Social Security #:

Enter principal owner's social security number.

D.O.B:

Enter principal owner's date of birth.

Home Address

Address:

Enter principal owner's address.

City:

State:

Zip Code:

Home Phone:

Enter principal owner's home phone number.

Mobile:

Enter principal owner's mobile number.

How long at home address:

Number of years at previous address:

Do you own or rent the house?
Own Rent

Estimated Current Annual Income ($):

Enter principal owner's estimated current annual income.

Authorization & Signatures

I/We hereby give permission to FastyFunding.com, or any agent or credit reporting agency that it may designate, to obtain any and all information concerning my/our assets and other credit matters, which they may require in connection with this credit Application. I/We specifically acknowledge(s) and agree(s) that (1) all statements which I/we have made in this Application are made for purposes of obtaining the financing, (2) verification and reverification of any information which I/we have supplied in connection with this Application may be made at any time by FastyFunding.com, either directly or through a credit reporting agency, from any source named in this Application and the original copy of the Application will be retained by FastyFunding.com, even if the financing is not approved, (3) FastyFunding.com will rely on the information which I/we have supplied herein and I/we have the continuing obligation to amend and/or supplement that information if any of the material facts which I/we have represented should change prior to the total obligations under the credit Agreement being paid in full and (4) each Guarantor, upon request from time to time by FastyFunding.com, will provide FastyFunding.com with financial statements and such other information as FastyFunding.com deems appropriate, all in form and detail satisfactory to FastyFunding.com. This Application is part of a credit review process and additional information may be required. I/we authorize FastyFunding.com to submit this Application and any credit reporting information obtained by FastyFunding.com in connection herewith from credit reporting agencies to one or more banks or lending institutions. Any institution considering this Application will make its own credit decision regarding this Application. The sales representative submitting this Application cannot extend credit or commit to any financing or funding until a credit decision has been made by the appropriate institution.

Signature of Merchant Authorized Signer & Loan Guarantor

Signature

Signatures are required

Date

Enter date.

Merchant Authorized Signer's Title:

Enter merchant authorized signer's title.