Giannina Nicoletti – Primo Cash Loan Application

Please read and check which applies to you

If you are applying for individual credit in your name and are relying on your own income or assets and not the income or assets of another person as the basis of repayment complete Owner Information (1) and omit Owner Information (2).

If this is an application for joint credit with another person complete Owner Information (1) and (2).

Date

Intended Use of Funds: *

Company Information

Legal Company Name *

State of Incorporation *

Federal Tax ID *

Physical Address (no PO Boxes) *

City *

State *

Zip Code *

Do you have an outstanding merchant cash advance? If YES how much is it? *

Company Phone Number *

Business Inception Date *

Does your business have a separate bank account? *

YES

NO

Rent or Own? *

Rent

Own

Has your business collected credit cards for the last three months? *

YES

NO

Landlord name *

Company Type/Industry *

Landlord phone *

Estimated Flow Overview

Your Annual Business Revenue? *

Your Average Bank Balance *

Your Monthly Credit Card Volume *

Funding Amount Requested *

Owner Information (1)

Name *

Email Address *

Home Phone Number *

Cell Phone Number *

SS Number *

Date of Birth *

Annual Income *

Home Address (No PO Boxes) *

City *

State *

Zip Code *

Business Ownership % *

Owner Information (2)

Name

Email Address

Home Phone Number

Cell Phone Number

SS Number

Date of Birth

Annual Income

Home Address (No PO Boxes)

City

State

Zip Code

Business Ownership %

Terms and Conditions

By signing and submitting your application , you certify that ( i ) you are authorized to apply on behalf of the company whose full legal name appears above under the part of the Company 's funding application a business funding from us and ( ii ) all information you provide on the funding application and other supporting documents is true and complete and that we notify you of material changes to this information. You understand and agree that we and our agents and assigns allowed to contact third parties to consult on the assessment of their funding application ( including requests for business reports and credit personnel offices of the credit reporting agencies and other sources) or for any update, renewal, extension of credit bureau to the undersigned person ( s ) and the company with third parties who may use the information for any lawful purpose , including for the purpose of offering credit and / or other products and services to people who sign ( s ) and / or company.

Your Signature *

Clear

Date

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