Application - JS ASSOCIATES US LLC

BUSINESS INFORMATION"*" indicates required fields Please note that your information is saved on our server as you enter it.

Legal/Corporate Name *

DBA *

Tax ID/EIN *

Entity Type *

Type Of Business *

Product/Service Offered *

Length Of Ownership *

Date Of Incorporation *

Phone Number *

Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Use Of Funds *

How Much Are You Looking For? *

Do You Accept Credit Cards? *

Do you currently have a cash advance? *

BUSINESS OWNER INFORMATION

First Name *

Last Name

Social Security Number *

Date Of Birth *

Owner % *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Home Phone *

Cell Phone *

Is there a business partner? *

Credit Score *

TermsThe Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to JS Associates US, LLC and 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, "Assassinates") 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 therefor (collectively, "Transactions"), and each Assent is authorized to use such information and documents, and share such information and documents with other Assassinates, in connection with potential Transactions, (4) Representative and each Assent will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assassinates, and each of their representatives, successors, assigns and design ( 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 over, 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.

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Date *

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