Full Application Prime

BUSINESS INFORMATION:

Corporate/Business Name:(Required)

DBA:(Required)

Company Website:(Required)

Date Company Established:(Required)

Entity Type(Required)

C-Corp

S-Corp

LLC

Sole Proprietorship

Partnership

Limited Partnership

State Formation(Required)

Address :(Required)

Phone #:(Required)

Company Email :(Required)

Annual Revenue(Required)

Company Name to be used for customer correspondence

PRINCIPAL/OWNERS/OFFICERS :

Name(Required)

Email(Required)

Driver Lic. #(Required)

SSN(Required)

Address :(Required)

% Business Ownership :(Required)

Homeowner :(Required)

Yes

No

Job Title:(Required)

Cell Phone :(Required)

Phone:(Required)

Date Of Birth :(Required)

What is your FICO score?(Required)

CORPORATE OFFICERS: - Include: Address, Telephone #, and Account #

President

Phone:

Vice President

Phone:

METTHODS OF FUNDS DISBURSEMENT

Method of Funds Disbursement(Required)

ACH transfer - No Cost

Wire Transfer - $18 each

Bank Name :(Required)

Account # :(Required)

Bank Routing # :(Required)

Address :(Required)

Phone # :(Required)

Contact :(Required)

ADDITIONAL INFORMATION:

Finncy and it's Partner's (Partner) is authorized to investigate my (our) credit reports, police records and any other public or private information supplier of data. Partner may verify any and all information given throughout this application or within any other documents provided to Partner. With reference to Partner's investigation, should any person, company or agency request specific written authorization to release requested information, photo copies or facsimiles of my (our) signatures below may be utilized to show my (our) acknowledgment and authorization to release requested information. I (we) hereby certify that all of the statements made throughout this application are true and correct.

Signature Officer/Owner/Partner(Required)

Title(Required)

Signature Officer/Owner/Partner(Required)

Title(Required)

Date Signed(Required)

I authorize ClientFinancing and partners to verify or obtain further information as it may deem necessary concerning the entity and its Partners and Owners, including the use of credit reporting agencies.

I or we if there is a co-applicant (the “Applicant” or “I”) acknowledge that by clicking the box, “I Accept & Agree with the Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link), I am indicating my intent to sign this Credit Application and that this shall constitute my/our signature. I acknowledge that I have viewed, read and agreed with the “Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link) before signing this completed Credit Application; and, I have signed this completed Credit Application with one or more electronic signatures and my electronic signature has the same effect as my written ink signature. I agree and acknowledge that by providing my name, social security number or tax payer identification number, birth date and/or other Identifying Information in the Credit Application Information, I confirm my intent to apply for credit, to sign the Credit Application and to provide the authorizations given above and confirm the validity of my signature. The Creditor (including any assignee, transferee, or successor of the Creditor, including, specifically, Home Acceptance Corporation) may rely on this authorization as if I had personally signed this completed Credit Application.

By clicking on the box, “I (the “Applicant”) Accept & Agree with the Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link)

AGREEMENT TO ARBITRATE (If You Check the Box): You (the “Applicant”) agree and accept the Arbitration Provision (contained in this website link), the Applicant or We may elect to resolve any dispute by neutral, binding arbitration and not by a court action (except, for a small claims court action). See the Arbitration Provision for additional information concerning the agreement to arbitrate.

All information will be held in strict confidence

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Merchant Enrollment Application