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Apex LOC Application Form

Merchant Information (Please Complete All Information Below Accurately)

Corporate Legal Address:

Multi-line address

Legal Form of Entity & Authorized Signer

Date of Organization:
Year
Month
Day

Information on Principal Owner/Loan Guarantor

Birthday
Year
Month
Day
Multi-line address
Are you a US citizen?
Yes
No
If not, are you a Permanent Resident?
Yes
No
Do you own or rent?
Own
Rent

Credit Authorization, Consents and Certifications

The Company and the undersigned principal owner of the Company identified above (“Applicant”) represent, acknowledge, and agree that (1) all information and documents provided to Ascendio (“Provider”) are true, accurate, and complete, (2) Applicant will immediately notify Provider of any change in Applicant's financial condition, (3) Provider is authorized to submit this Application and all supporting documents provided by Applicant to its affiliates, representatives, successors, assigns, designees, agents, partners, and third-party financial institutions for the purpose of considering commercial financing offers to Applicant (collectively "Recipients"), (4) such Recipients are authorized to request and receive any investigative reports, consumer credit reports, statements from creditors or financial institutions, verifications of information, or any

other information that the Recipients deem necessary in considering this Application, (5) the undersigned represents that they are authorized to sign this form on behalf of the Company, and (6) THE COMPANY AND PRINCIPAL CONSENT TO RECEIVE CALLS, TEXTS, AND EMAILS FROM PROVIDER AND RECIPIENTS BASED UPON THE CONTACT

INFORMATION OF APPLICANT PROVIDED IN THIS APPLICATION.

Signature by Merchant Authorized Sign your text

Signature by Merchant Authorized Signer & Loan Guarantor

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Date
Year
Month
Day
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