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BUSINESS INFORMATION












PRIMARY OWNER INFORMATION

SECONDARY OWNER INFORMATION


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SECONDARY OWNER INFORMATION














FINANCIAL INFORMATION





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YesNo



AUTHORIZATION

By signing below, each of the above listed business and business owner/officer (individually and collectively,"you") authorize 75 Capital LLC 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 75 Capital LLC transactions, including without limitation the application therefor (collectively, "Transactions" )to obtain consumer or personal, business and investigative reports and other information about you, including creditcard processor statements and bankstatements, 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 authorize 75 Capital LLC 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 there lease, by any creditor or financial institution, of any information relating to any of you, to 75 Capital LLC and to each of the Recipients, on its own behalf."


In Addition, you expressly consent to receiving marketing and other calls and messages, to landline, wireless or similar devices, including auto dialed and pre-recorded messagecalls, and SMS messages(including textmessages) from Recipients, at telephone numbers that you have provided. Message and data rates may apply. Your consent to receive marketing calls is not required for your application; if you do not consent do not provide cell phonenumber.

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