Business Application Disclosures

BUSINESS APPLICATION DISCLOSURES

RECITALS

WHEREAS, Applicant has submitted an application to Recipient for consideration of credit, procurement, or other commercial relationship as described in this document and accompanying materials; and

WHEREAS, Recipient requires certain disclosures, certifications and authorizations from Applicant to evaluate the application, perform due diligence, and document agreed terms; and

WHEREAS, the parties intend that the statements, representations and disclosures contained herein be relied upon by Recipient in determining Applicant's eligibility and terms of any credit or commercial arrangement.

APPLICANT INFORMATION

Entity Type: Corporation LLC Partnership Sole Proprietor Other

OWNERSHIP AND CONTROL

List all individuals or entities holding 20% or more ownership or having material control. Attach additional sheets if necessary.

DISCLOSURES

The undersigned Applicant hereby discloses the following. Check each box that applies and provide a concise explanation for any checked item.

Applicant or any principal has filed for bankruptcy within the last 7 years.
Applicant is party to any material litigation, arbitration, or governmental investigation.
Applicant has outstanding tax liens, judgments, or government enforcement actions.
Applicant is currently in default under any indebtedness or lease.
Applicant has been subject to adverse regulatory action or license suspension.

FINANCIAL INFORMATION

SCOPE OF WORK / USE OF PROCEEDS

Describe the intended use of funds, goods, services or purpose of this application. This description will be relied upon by Recipient in structuring any agreement.

PAYMENT TERMS

Applicant agrees to pay non-refundable application and administrative fees as set forth below. Fees and schedules are subject to final written agreement.

TERM AND TERMINATION

This disclosure and any subsequent processing shall commence on and shall remain in effect until unless earlier terminated in accordance with this paragraph.

Either party may terminate consideration of the application upon written notice to the other party. Notice shall be provided not less than days prior to termination, except that Recipient may suspend processing immediately for material misrepresentation or nonpayment of required fees.

CONFIDENTIALITY

Applicant acknowledges that information provided to Recipient, including financial statements, tax returns, credit reports and internal business plans, constitutes Confidential Information. Recipient shall hold Confidential Information in confidence and shall not disclose such information except to its officers, agents, advisors, or as required by law or court order. Confidential obligations survive termination for a period of unless otherwise agreed in writing.

GOVERNING LAW

This document and any resulting agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

ENTIRE AGREEMENT

Applicant and Recipient acknowledge that this Business Application Disclosures form, together with any attachments incorporated by reference, constitutes the entire understanding between the parties with respect to the matters herein and supersedes all prior discussions and agreements. No amendment shall be effective unless in writing and signed by both parties.

CERTIFICATIONS AND AUTHORIZATIONS

The undersigned certifies that all information provided in this application and any attachments is true, correct and complete. Applicant authorizes Recipient and its agents to verify any information provided, including obtaining credit reports, criminal background checks, public filings and contacting trade and banking references. Applicant agrees to promptly notify Recipient of any material change in the information supplied.

I certify the information provided is true and complete under penalty of perjury.
I authorize Recipient to obtain consumer and business credit reports as necessary to evaluate this application.
I authorize Recipient to conduct background and reference checks on principals disclosed herein.

Most recent financial statements
Most recent tax returns
Business plan / use of proceeds
Articles of incorporation / organization
Additional documents (describe below)

MISCELLANEOUS PROVISIONS

The parties agree that any notices required under this document shall be in writing and delivered to the addresses set forth above or to such other address as either party may designate in writing. If any provision of this document is held invalid, the remaining provisions shall continue in full force and effect.

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