Thank you for your interest in Imperial Advance. Attached you will find your Application for funding. Please complete the application in its entirety and return it along with:  6 months Bank statements (All Pages)  Profit and loss statement with balance sheet ($75k+)   Fill out application (attached) In order to ultimately fund you, I will also need the following, so if you have it handy, please send it along now:  Copy of your lease or deed ( page with terms and signature)  Drivers License  Voided check  Business Certificate Once we receive your completed, signed application along with the aforementioned documentation, we will promptly contact you with specific information including, how much money you qualify for and when we can ACH these funds into your account. Sincerely,

Michael Buchanan Office: 347-708-7412 Fax: 866-323-9373 Email: mbuchanan@imperialadvance.com

Working Capital Application 132 W 36th St 3rd Floor, New York, NY 10018 www.ImperialAdvance.com
Legal/Corporate Name: Physical Address: Telephone #: Date Business Started: Type of Entity (circle one): Sole Proprietorship Partnership Fax #: Length of Ownership:

Representative: Michael Buchanan Phone #: 347-708-7412 Fax #: 866-323-9373 Email: mbuchanan@imperialadvance.com
BUSINESS INFORMATION
DBA: City: State: Federal Tax ID: Website: Email Address: Product/Service Sold: Gross Annual Sales: Zip:

Corporation

LLC

Other Other

Type of Business (circle all that apply): Retail MO/TO Wholesale Restaurant Use of Proceeds:

Supermarket

OWNER/OFFICER INFORMATION Owner/Officer Name: Home Address: SSN: Date of Birth: Title: City: Home #: Ownership %: State: Cell #: Zip: FICO Score:

PARTNER INFORMATION (if owner/officer ownership % less than 50%) Partner Name: Home Address: SSN: Date of Birth: Title: City: Home #: BUSINESS PROPERTY INFORMATION Business Landlord or Business Mortgage Bank: Own/Lease: (circle one): Contact Name and/or Account #: Monthly Rent or Mortgage: OTHER INFORMATION Credit Card Processing Terminal(s)/Software Model: Requested Funding Amount: Number of Terminals: Average Monthly Volume: Phone #: Ownership %: State: Cell #: Zip: FICO Score:

Do you Accept: Visa/MasterCard Amex Discover Debit EBT Please circle all that apply. Prior/Current Merchant Cash Advance Company (if applicable): Balance: Underwriter Use Only Split Funds ACH The Merchant and Owner(s)/Officer(s) identified above (collectively referred to herein as an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Imperial Advance, LLC (“Imperial”) and any of its affiliates and agents, including without limitation, credit card processor statements are true, accurate and complete and contain a complete representation of all material facts as of this date, (2) Applicant will immediately notify Imperial of any change in such information or in its financial condition, (3) Applicant authorizes Imperial to disclose all information and documents that Imperial may obtain to other persons or entities (collectively, “Assignees“) 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“), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) each Assignee will rely upon the accuracy and completeness of such information and documents. Applicant on behalf of Merchant and any individuals named in the application expressly understands, agrees and acknowledges that Imperial, Assignees, and each of their respective representatives, successors, assigns and designees (collectively, “Recipients”) may request and obtain consumer credit reports, other investigative consumer reports from one or more credit reporting agencies, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary in connection with Applicant's application and the administration of its account and obtain all information necessary to complete this application. Applicant also expressly authorizes such parties to exchange and divulge credit and other relevant information, data and records concerning Applicant or its account with (and answer questions and requests from) others, such as lenders and credit reporting agencies as may be necessary in connection with this application and any Transactions. On request, Applicant can receive a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act” prepared pursuant to 15 U.S.C. § 1681g(c). The Applicant hereby Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of such information. Each Owner/Officer represents that he or she is authorized and has the necessary power to sign this form on behalf of Merchant.

Applicant’s Signature

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Applicant’s Signature

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