FUNDING PRE-QUAlification form CONTACT INFORMATION Business Legal Name *Business DBA (if applicable)Business Phone *Mobile PhoneBusiness FaxOther PhoneWebsite *Email *Physical Address *City *State *ZIp *Mailing Address *City *State *ZIp * BUSINESS INFORMATION Legal Entity (select one) *CorporationLLCPartnershipLPLLPSole ProprietorshipBusiness Start Date *Federal Tax ID: *Home Based Business *YESNoOpen Judgements/Lines? *YESNoOpen Bankruptcies? *YESNoState of Inc/LLC *Business DescriptionIndustry Type(SIC Code)Business Rent/Mortage InformationRented/LeasedMortagedMthly/Lease/Mtg PaymentRemaining Term for Rent/LeasePayment Current?YESNOLandlord/Mortage Company ContactPhone Number * FUNDING INFORMATION Amount RequestedWhen Are Funds Needed:ASAP30 Days60+ DaysDesired Use of Funding ProceedsGross Annual SalesGross Monthly SalesMonthly Credits Card VolumeCurrent Cash Advance?YESNOCash Advance/Loan BalanceCurrent Credit Card Processing CompanyAccount Number * OWNER/PRINCIPAL INFORMATION First Name *MILast NameTitle%Ownership *Home Address *City *State *Zip *Home Phone *Mobile Phone *Date of Birth *SS# * CO-OWNER/PRINCIPAL INFORMATION First NameMILast NameTitle%OwnershipHome AddressCityStateZipHome PhoneMobile PhoneDate of BirthSS# AUTHORIZATION By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) Quick Advance Funding 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 therefore (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 Quick Advance Funding to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Quick Printed NamePrinted NameDateDate SUBMIT Email signed Pre-Qualification Form to: info@metacapconsulting.com