BUSINESS INFORMATION Legal Name of Company: Registered Trade Name (D.B.A.): Corporate Headquarters: Street Address: Country Select CountryUnited States *State/Province Select StateAlabamaAlaskaAmerican SamoaArizonaArkansasBaker IslandCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiHowland IslandIdahoIllinoisIndianaIowaJarvis IslandJohnston AtollKansasKentuckyKingman ReefLouisianaMaineMarylandMassachusettsMichiganMidway AtollMinnesotaMississippiMissouriMontanaNavassa IslandNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalmyra AtollPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUnited States Virgin IslandsUtahVermontVirginiaWake IslandWashingtonWest VirginiaWisconsinWyomingOther StateReset City Select CityReset Postal Code/Zip Business Telephone: Business Fax: Primary Contact regarding this Application: Web Address: E-mail Address Years in Business: State Business Established Is Business a CorporationPartnershipLLCIndividualOther Describe Business/Products Any subsidiaries, licensees or affiliates? yesno Has company ever filed for bankruptcy? yesno Any Federal or State taxes past due? yesno Are there any judgments pending by or against the company? Is there any pending or threatened litigation against the company? Federal Tax ID: PRINCIPALS OF BUSINESS Name Title % Owned Social Security # Phone Home Address Name Title % Owned Social Security # Phone Home Address Name Title % Owned Social Security # Phone Home Address Name Title % Owned Social Security # Phone Home Address If there are additional Principals, provide details on a separate sheet of paper. Have any of the Principals of this Business ever filed for bankruptcy? yesno Is there litigation pending against this business or the principals? yesno BUSINESS LOANS Financial Institution: Contact Phone Loan Amount: $ Are Accounts Receivable and/or inventory pledged as collateral? yesno ACCOUNTS RECEIVABLE INFORMATION Amount of open Receivables (Total Outstanding): $ Aging of Receivables ($ Amount): 0-30 days: $ Aging of Receivables ($ Amount): 31-60 days: $ Aging of Receivables ($ Amount): 61-90 days: Aging of Receivables ($ Amount): Over 90 days: $ Is business currently or has it previously factored its receivables? yesno If currently factoring, with whom? Average monthly amount company wants to factor: $ LIST 3 LARGEST ACCOUNTS YOU EXPECT TO FACTOR Company Name: Monthly Sales to Account: $ Desired amount of credit $ Contact Name: Phone Address Company Name: Monthly Sales to Account: $ Desired amount of credit $ Contact Name: Phone Address Company Name: Monthly Sales to Account: $ Desired amount of credit $ Contact Name: Phone Address Where did you hear about us? To expedite application evaluation, please provide the following, if available: If a start‐up and available, Copy of Business PlanAccounts Receivable Aging ReportAccounts Payable Aging ReportFor prior year and Year‐to‐date: Profit & Loss Statement and Balance Sheets. Credit Authorization I authorize I hereby certify that the information contained in this credit application is true and accurate and I hereby authorize ACG, its partners, and lenders to obtain consumer credit reports relating to individual credit history and/or creditworthiness and any other information regarding Commercial Applicant and its owners and principals from third parties to verify any information provided on the Application. I hereby authorize the filing and recording of UCC financing statements showing the Lender’s interest in all the business assets and grant ACG the right to execute them in our company name or by the representative. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for update, renewal, or extension of such credit or additional credit and for reviewing or collecting the resulting account. I/we affirm my/our identity as the respective individual(s) identified in this application.