Funding Application

Business Information:

Business Legal Name:

Business DBA:

Tax ID Number:

State of Incorporation

Estimated Start Date:

Business Address

City

Region/State/Province

Postal / Zip code

Personal Information:

First Name:

Last name:

Title:

SSN#:

Date of Birth:

Ownership Percentage

Home Address

City

Region/State/Province

Postal / Zip code

$ Amount Requested:

Best Contact Email

Best Contact Number

By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Breeze Capital LLC ("CV") and each of its representatives, successors, assignees and designees ("recipients") that may be involved with or acquire commercial Joans having daily repayment features or purchases of future receivables including merchant cash advance transactions, including without limitations the application therefor (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, Equifax and from other credit bureaus, banks and creditors and other third parties. You also authorize CV to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the recipients for the forgoing purposes.. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, the CV and to each of the following recipient, on its own behalf.

Your Signature