Business name *

Business Alias/DBA Name:

Company Website URL (if applicable):

Address

Street Address *

City *

State *

Zip / Postal Code *

First Name *

Last Name *

Email *

Business Phone: *

Corporate Officer First Name: *

Corporate Officer Last Name: *

Corporate Officer Title: *

Officer Street Address *

Officer Street Address 2

Officer City *

Officer State *

Officer Zip Code *

Ownership %: *

Corporate Officer SSN: *

Corporate Officer Credit Score: *

Corporate Officer Date of birth: *

Cell Phone: *

Second Owner: *

Yes

No

Second Owner First Name: *

Second Owner Last Name: *

Second Owner Phone Number: *

Second Owner Email: *

Second Owner Title: *

Second Owner Street Address: *

Second Owner Street Address Line 2:

Second Owner City: *

Second Owner State *

Second Owner Zip Code: *

Second Owner %: *

Second Owner SSN: *

Second Owner Credit Score: *

Second Owner DOB: *

Please upload your most recent 4 months of business bank statements.

Accepted file types: pdf, jpg, png, doc, docx, psd, xls, xlsx, txt, Max. file size: 256 MB, Max. files: 10.

Terms and Conditions *

I agree to the following terms

By signing above, each of the above listed businesses and business owner/officer (individuallyand collectively, "you") authorize Bluegrass Lending Group Inc and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial business loans having daily/weekly repayment features or purchases of future receivables including Revenue-Based Financing transactions, including without limitation the application therefor (collectively, "Transactions") to obtain consumer and/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 and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Bluegrass Lending Group Inc to transmit this Application, with any of the foregoing information submitted/obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Bluegrass Lending Group Inc and to each of the Recipients, on its own behalf. You intend to sign this Application electronically and consent to transacting business with Bluegrass Lending Group Inc and its affiliates electronically. You are providing your business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions with Bluegrass Lending Group Inc and/or its affiliates on either medium. You also hereby consent tothe receipt of text messages knowing that msg and data rates may apply. You understand that consent to conduct business via electronic signatures and to receive text messages are not a condition of approval and you may opt-out of either/both by contacting Bluegrass Lending Group Inc at [email protected]. Your signature above certifies that you are authorized to sign this application on behalf of the Business and all the information contained herein is complete, true and accurate.

Signature: *

Clear

Second Owner Signature:

Clear

Submission Date: *