Application for Factoring

3. Disclosure & Signatures

Please Attach The Following Items With Your Business Application

*Photocopy of Driver's License

*W9

*Insurance Certificate

*Articles of Incorporation

*Voided Check

I hereby certify that all information contained in this application is correct. I hereby authorize Capital Hart Corp., its subsidiaries, its designated agents, or assigns to conduct any investigation it sees fit as to the creditworthiness of the company and all principals individually. I authorize Capital Hart Corp. to conduct credit, criminal, and civil background checks as a condition of financing. I also authorize the use of law enforcement agencies, third-party credit agencies, and/or private background check organizations to assist in collecting this information. I understand that the contents of said investigation and any ensuing reports will be, and remain, confidential. Without limiting the generality of the foregoing, I hereby authorize Capital Hart Corp., its subsidiaries, agents, and assigns to use, collect, and disclose the foregoing information for the purposes stated herein. Capital Hart Corp. will take reasonable precautions to safeguard such information to prevent theft, loss, or unauthorized disclosure.

Sign Individually, with Title: Please have all principals sign below:

*Applicant1 Signature

*Print Name

*Date

support@capitalhart.com

800-299-2109

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Application for Factoring

1. Personal Information

Application for Factoring

2. Personal Information

Applicant 1

Applicant 2

Application for Factoring

3. Disclosure & Signatures

Please Attach The Following Items With Your Business Application

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