General Background: Merchant Information

Type of Entity (check one) __corporation ___limited liability company __partnership __limited partnership __limited liability partnership __sole proprietorship

Merchants Legal Name D/B/A

Physical Address City, State, Zip

Mailing Address / Billing Address City, State, Zip

State of Incorporation/Organization Business Type; Product/Service Sold Date business started (mm/yy)

Contact Name Position Email Address

Merchant Ownership Information: Owner No. 1 Percentage (______%) of Ownership

Residence Address City, State, Zip

Merchant Ownership Information: Owner No. 2 Percentage (______%) of Ownership

Residence Address City, State, Zip

Sales & Credit Card Processing Information

Visa/MasterCard: Card Swipe ______% Manually Keyed______% Phone/Mail Order ______% Internet ______% Total (100%)

Seasonal Sales: ❏ Yes ❏ No If yes, high volume months: ❏ Jan ❏ Feb ❏ Mar ❏ Apr ❏ May ❏ Jun ❏ Jul ❏ Aug ❏ Sep ❏ Oct ❏ Nov ❏ Dec

Funding Information

Business Property InformationOwn/Lease Lease Start Date Lease Term Mthly Rent/Mtg Type of Building Square Footage (approx)

Other InformationDid you enclose any additional information? Sales Representative (Please Print) Sales Agent # Contract #

Merchant Application

Authorized Merchant Signature(s) Date

1. Application must include a copy of a voided check.

2. TCF will conduct independent due diligence of each Merchant that desires financing from TCF, and TCF may deny financing to any applicant at its sole discretion.3. Merchant acknowledges and agrees that a consumer or investigative report, including a credit check with recognized credit reporting agency(s), may be conducted in connection with this Application. Merchant hereby

authorizes TCF and its agents and representatives to (i) initiate such reports, investigations and/or credit checks, (ii) investigate anystatements made or data received from or about Merhant and/or its owners/shareholders, and (iii) contact any references given by Merchant or its owners/shareholders.

FAX COMPLETED APPLICATION TO: 866-496-7046

Web Address

Length of Ownership

Federal ID (or SS# for Sole Proprietorship)

Use of Proceeds

Business Fax

Business Phone

Avg. Gross Monthly Volume (Cash, Checks, Credit Cards)

Software Type / POS System Software Type / POS System - Contact Name & PhoneTerminal Make & Model# of Terminals

Email Address

Email Address

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