The document is an authorization form for Blue Granite Funding Group LLC to obtain an applicant's credit report and other financial information for the purpose of providing a working capital advance or merchant cash advance. By signing, the applicant certifies that the information provided is accurate and authorizes Blue Granite Funding to share the information with other potential lenders or funding sources. The applicant also agrees to notify Blue Granite Funding of any changes to the information or financial condition and waives any claims related to the use of the information.

1. By signing above I/We certify the information above is true and understand that making false statements might be considered fraud. Applicant named above hereby authorizes Blue Granite Funding Group
LLC, its affiliates, assigns, agents, banks or financial institution to obtain an investigative report submitted by applicant for purpose of obtaining a working capital advance. AUTHORIZATION FORM The
Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Representative including
credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or financial condition, (3) Applicant authorizes
Representative to disclose all information and documents that Representative may obtain including credit reports to other persons or entities (collectively, "Assignees") that may be involved with or acquire
commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively,
"Transactions"), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4)
Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns
and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any
other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information providers arising from any act or omission relating to the requesting,
receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of aMuethrcohraiznatt.ioAncmopay obfethaicscepted as an original. The
term “Representative” shall mean any funding source looking to offer, make available, or provide to the Merchant access to loans or merchant cash advances based on such Merchant’s future receivables or
sales and/or structured with a periodic repayment feature. Owner/Officer(s): AUTHORIZATIONFORM The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents,
acknowledges and agrees that (1) all information and documents provided to Representative including credit card processor statements are true, accurate and complete, (2) Applicant will immediately
notify Representative of any change in such information or financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain including
credit reports to other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including
Merchant Cash Advance transactions, including without limitation the application therefore (collectively, "Transactions"), and each Assignee is authorized to use such information and documents, and share
such information and documents with other Assignees, in connection with potential Transactions, (4) Representative and each Assignee will rely upon the accuracy and completeness of such information and
documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports,
credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against
Recipients and any information providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to
sign this form on behalf of Merchant. A copy of this authorization may be accepted as an original. The term “Representative” shall mean any funding source looking to offer, make available, or provide to the
Merchant access to loans or merchant cash advances based on such Merchant’s future receivables or sales and/or structured with a periodic repayment feature.
Business Legal Name:
Address: Suite/Floor
Phone: Fax:
Business Start Date (month/year): length of Ownership:
E-mail:
Landlord/MortgageCompany:
Landlord Contact Name:
Principal (1) Name: Title: Mr Mrs
Address:
Phone: Fax:
Business Start Date (month/year): length of Ownership:
Principal (2) Name: Title: Mr Mrs
Address:
Phone: Fax:
E-mail:
Business DBA Name:
City: State: Zip:
Mobile: Tax ID#:
Legal Entity: Corp Sole Prop LLC
Partnership Industry Type:
Website:
Rent/Mortgage Payment: Lease Expiration:
Landlord Contact Phone: Landlord Contact Fax:
Mobile: %Ownership:
City: State: Zip:
Date of Birth: Social Security #:
Signature: Date:
x
Mobile: %Ownership:
City: State: Zip:
Date of Birth: Social Security #:
PLEASE FAX OR EMAIL APPLICATION ATTACHED
WITH 4 MONTHS OF THE BUSINESS'
BANK STATEMENTS
Desired Advance Amount: Minimum Advance Average Ticket Size:
Average Monthly Visa/Master Card Sales: Average Monthly Total Sales:
Proposed Use of Funds: Current Processing Company:
Has applicant ever been in bankruptcy? YES NO Are any suits/judgments/liens pending against
the applicant: YES NO
Do you have an OPEN cash advance? YES NO Have you used a cash advance plan before? YES NO
If YES, what is the balance IF YES, with who:
Toll Free Office 844.434.8902 | Direct 718.355.9516 | Fax 917.791.9811 | www.BlueGraniteFunding.com
Office: 1-844-434-8902 | Fax: 1-917-791-9811
Submissions@BlueGraniteFunding.com
PRINCIPAL / OWNER DETAILS
FUNDING DETAILS
Thomas Trimarco
Admins@BlueGraniteFunding.com (347) 884-0831 - Mobile