The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents,
acknowledges and agrees that (1) all information and documents provided to GoKapital, Inc.
(“Company”) including credit card processor statements are true, accurate and complete, (2) Applicant
will immediately notify Company of any change in such information or financial condition, (3) Applicant
authorizes Company to disclose all information and documents that Company may obtain including
credit reports to other persons or entities (collectively, “Assignees”) that may be involved with or acquire
commercial loans or purchases of future receivables including Merchant Cash Advance transactions,
including without limitation the application therefore (collectively, “Transactions”) and each assignee is
authorized to use such information and documents and share such information and documents with
other Assignees, in connection with potential Transactions, (4) Each Assignee will rely upon the
accuracy and completeness of such information and documents (5) Company, Assignees, and each of
their representatives, successors, assigns and designees (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.