Name *
Name
Mobile *
Mobile
Office
Office
Date of Birth *
Date of Birth
Authorization to Underwrite *
By checking this Box, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Royalty Capital] (“RC”) and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily, weekly, or monthly repayment features or purchases of future receivables, 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 RC 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 RC and to each of the Recipients, on its own behalf.”