Funding Application

Step 1/4 - Merchant Pre-Qualification Form

Business Legal Name *

Business DBA Name

Legal Entity Type *

Federal Tax ID (EIN) *

State of Incorporation *

Physical Address *

City *

State *

ZIP *

Business Phone Number *

Business Start Date *

Use of Proceeds

Products/Services Provided *

Step 2/4 - Financial Information

Existing MCA or Loan Account? YesNo

Company

Balance $

Gross Monthly Sales $

Step 3/4 - Owner/Principal Information

Owner / Principal Information #1

First Name *

Last Name *

Title

% of Ownership

Address *

City *

State *

ZIP *

Mobile *

Email *

Date of Birth

SSN #

Owner / Principal Information #2

First Name

Last Name

Title

% of Ownership

Address

City

State

ZIP

Mobile

Date of Birth

SSN #

By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize [Top Choice Financial, LLC] ("TCF") 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 therefor (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 TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize TCF to transmit this application form, 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 also consent to the release, by any creditor of financial institution, of any information relating to any of you, to TCF and to each of the Recipients, on its own behalf.

Owner Print Name *

Date

Principal Print Name

Date

Step 4/4 - Attachments

Bank Statements

Driver’s License

Void Check ^{(for corresponding account to provided bank statements)}

Credit Card Statements

Tax Return / Financials Statements

Funding Application

Step 1/4 - Merchant Pre-Qualification Form

Step 2/4 - Financial Information

Step 3/4 - Owner/Principal Information

Owner / Principal Information #1

Owner / Principal Information #2

Step 4/4 - Attachments

Solutions

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