Apply Online - Lux Business Solutions, LLC

Company Name*

DBA Name

Federal Tax ID*

Company Type*

Description of Business*

Business Property Rent or Own?*

Rent
Own

Rent/Mortgage Paid

FICO Score

Gross Annual Revenue*

Business Start Date Under Current Ownership*

Business Mailing Address*

Street Address City State ZIP Code

Is your physical address different than your mailing address?

No
Yes

Physical Address

Street Address City State ZIP Code

Company Phone Number*

Mobile*

Fax number

Email*

Existing MCA?*

Yes
No

If yes, how much?

Which company?

Owner Information (1)

First Name*

Last Name*

Social Security Number*

Date of Birth*

Email*

Home Phone

Cell Phone*

Home Address*

Street Address City State ZIP Code

Percentage Owned*

Is there a second owner?

No
Yes

Owner Information (2)

First Name*

Last Name*

Social Security Number*

Date of Birth

Email*

Home Phone

Cell Phone*

Address*

Street Address City State ZIP Code

Percentage Owned*

Desired Loan Amount*

Desired Loan Term*

Purpose of Loan

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By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize [Lux Business Solutions] ("LBS") and each of its representatives, successors, assigns and designees ("Recipients") 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") to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies , such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize LBS to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to LBS and to each of the Recipients, on its own behalf

Owner (1) Signature*

Owner (2) Signature