Short Form Merchant Application & Authorization To Review Credit

American Easy Funding LLC

Funding Made Easy.

6803 Madison Street, 1st Floor Guttenberg, NJ 07093 Phone: (201) 539-9376 Email: Shepperle@icloud.com

Legal Business Name:

D/B/A Name:

Physical Address:

Business Fax:

Email:

Est. Total Monthly Sales:

Est. Monthly Credit Card Sales:

Years in Business:

Banking Institution for Business Account(s):

Has this Bank Account Been Open for at Least 90 Days?

Yes

Time Remaining on Site Lease/Mortgage:

Business Type:

Landlord/Agent Name:

Landlord/Agent Phone #:

Number of Locations:

9 Digit Federal Tax ID#:

Is Your Business for Sale?

Yes

$Amount Requested:

Have you ever filed for bankruptcy?

Yes

Intended Use of Money:

Do you have any federal or state tax liens?

Yes

Type of Entity (Corporation, Sole Proprietorship, etc.),

Name of Authorized Signer

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Title of Authorized Signer:,

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Principal Owner Information (Please Complete ALL Information Below Accurately)

Are you a US Citizen or Permanent Resident O Yes ONo

Yes

% Ownership:

Score:

Principal Owner Name:

Social Security #:

D.0.B:

Home Address:

City:

State:

Zip:

Home Phone:

Mobile:

How Long at Home Address:

Number of years at previous home address:

Own

Rent

I/We hereby give permission to American Easy Funding LLC (AEF), or any agent or credit-reporting agency that it may designate, to obtain any and all Information concerning my/our assets and other credit matters, which they may require in connection with this credit Application. IWe specifically acknowledge(s) and agree(s) that (1) all statements which I/we have made In this Application are made for purposes of obtaining the financing, (2) verification and reverification of any Information which I/we have supplled In connection with this Application may be made at any time by AEF, either directly or through a credit reporting agency, from any source named in this Application and the original copy of the Application will be retalned by AEF, even if the financing is not approved, (3) AEF will rely on the Information which I/we have supplied herein and I/we have the continuing obligation to amend and/or supplement that Information if any of the material facts which I/we have represented should change prior to the total obligations under the credit Agreement being paid in full and (4) each Guarantor, upon request from time to time by AEF, will provide AEF with financial statements and such other information as AEF deems appropriate, all in form and detall satisfactory to AEF. This Application is part of a credit review process and additional Information may be required. I/we authorize AEF to submit this Application and any credit reporting Information obtained by AEF in connection herewith from credit reporting agencies to one or more banks or lending Institutions. Any Institution considering this Application will make its own credit decision regarding this Application. The sales representative submitting this Application cannot extend credit or commit to any financing or funding until a credit decision has been made by the appropriate institution.

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1(800)532-4593

American Easy Funding LLC Form

Short Form Merchant Application & Authorization To Review Credit

American Easy Funding LLC

Principal Owner Information (Please Complete ALL Information Below Accurately)