Business Information

Business Description Renter or Owned Rent/Mortgage Amount Landlord/Mortgage Company Contact Open Bankruptcy? Any Open Judgments? Any Tax Liens? Do you currently have any loans? If yes, what kinds and what is the balance? Explain changes in Sales/Profit, or Debt (+/-10%) How much Capital is being requested? What is the Capital being requested for?

MCA Term Loan Line of Credit Other

Visa/MasterCard Monthly Volume Repayment Terms: Total Monthly Sales (All Forms of Revenue) Gross Annual Sales (Last year's Tax Return) Number of Customers Is your business seasonal?

Yes No

What are your businesses growth plans for the next 3 to 5years? Broker? (Who referred you to us?) By signing this form, you are providing written instructions to LNS Group LLC/LNS Capital Partners under the Fair Credit Reporting Act

authorizing LNS Group/LNS Capital Partners to obtain from your personal credit profile or other information from MicroBilt.

You authorize LNS Group/LNS Capital Partners to obtain such information solely to conduct a pre-qualification for credit. Credit information accessed for my pre-qualification request may be different than the Credit Information accessed by a credit grantor on a date after the date of my original pre-qualification request.

Print Name Date Please upload: 3 current months Bank statements (all pages), Drivers License , EIN Letter, Corporate Formation Documents.

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