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Legal Business Name

Year Business Started

Industry

Average Monthly Revenue

Estimated Credit Score

EIN (Employer Identification Number)

Your Contact Information

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First Name

Last Name

Email Address

Phone Number

Social Security Number

Date of Birth

By signing below, each of the above listed business and business owner (individually and collectively, “you”) authorize LAG Holdings LLC DBA Logic Advance Group (“Representative”) and each of its representatives, successors, assigns and designees and third-party funding partners, which includes lenders and other finance providers, (“Recipients”) that may be involved with or acquire commercial loans or working capital funding with daily and/or weekly repayment features or purchase of future receivables including Business Advance transactions, including without limitation the application therefor (collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor and bank statements, from one or more consumer reporting agencies, and from other credit bureaus, banks, creditors and other third parties. You also authorize representatives to transmit this application, along with the foregoing information 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 you, to representative and to each of the recipients on its own behalf. You also consent to being contacted by email or phone on the email or phone number identifies as belonging to you, including wireless numbers (if applicable), even if listed on the Do-Not-Call registry, including by text, automated telephone dialing system, artificial voice or other similar system with respect to this application.

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