Hurlington Finance

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Application Dossier

Complete the formal intake below. Required fields are marked with an asterisk, and all optional application fields are submitted as empty strings when left blank.

Application Dossier

Formal progress indicator: 0 of 5 sections complete.

Business

Legal Company Name *Entity Type *Federal Tax ID *State of Incorporation *Business Inception Date *Business AddressBusiness CityBusiness StateBusiness ZIP

Primary Owner

First Name *Last Name *Owner EmailSSN *Date of Birth *Cell PhoneOwner AddressOwner CityOwner StateOwner ZIPOwnership Percentage *

Is there a 2nd Owner? *

Owner 1 name generated for submission: Pending

Documents

Bank Statements *One or multiple files. PDF, JPG, JPEG or PNG. 10 MB each.Business Tax Return *One or multiple PDFs. 10 MB each.

Disclosures and Owner 1 Signature

The above hereby authorizes Hurlington Finance, on a on exclusive basis, to seek financial transactions on its behalf from the date stated herein, and otherwise from time to time until any and all loans and/or revenue based financings are repaid in full and the relationship with the merchant is completed, including but not limited to for any renewal or for any purpose relating thereto.

By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted in connection with this application are true, correct, and complete; and (2) authorize Hurlington Finance and its assignees/designees to obtain credit reports and any other information regarding the Merchant and its owners and principals to verify the information provided on the application.

I have read and agree to the authorization, certification and credit-report disclosure above.