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By signing and submitting to Libertas Funding LLC (“Libertas Funding LLC”, “us”, “we”) this business Advance  application (“Advance  Application”) for the company identified in the Company Information section above (“Company”), the person signing this Advance  Application (“you”,”your”) certifies that (i) you have the authority to apply, on behalf of the Company, for a business Advance  from Libertas Funding LLC, (ii) all information provided in this Advance  Application and any other supporting documents is true and correct and complete (and we will be notified of any changes to this information), (iii) you understand that to help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person and entity applying for credit, and therefore, when your company applies for credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you and your company, and we may also ask to see your driver’s license or other documents identifying you and your company, (iv) you agree to Libertas Funding LLC’s Application Agreement on Libertas Funding LLC’s website (, (v) you consent to receiving calls and messages, including autodialed calls for marketing purposes, from Libertas Funding LLC or its representatives or agents at the telephone numbers that you provide (including any mobile telephone numbers you provide), and you acknowledge that no purchase of credit or services is contingent upon such consent, (vi) you acknowledge that telephone calls to and from Libertas Funding LLC may be recorded, and (vii) you acknowledge you have read Libertas Funding LLC’s Privacy Policy on Libertas Funding LLC’s website (, and understand that you may opt out of receiving communications of your choice from Libertas Funding LLC as provided in that Privacy Policy. You understand and agree that Libertas Funding LLC, its representatives, agents or assignees are authorized by you and the Company to order and conduct background checks and other investigative reports on you and the Company (including credit bureau reports from credit bureau agencies, and reports from other sources), and to contact third parties, all in furtherance of evaluating this Advance Application, and we have authority for the foregoing in connection with any update, renewal, or extension of credit or Advance s to the Company from Libertas Funding LLC. You understand and agree that, in accordance with the Libertas Funding LLC Privacy Policy, we may provide credit and other information provided in this Advance  Application to third parties who may use the information for lawful purposes, including but not limited to the offering of other products and services to the Company. If you use the services of an Advance broker to apply for a Advance  with Libertas Funding LLC, you understand and agree that we may provide to your Advance  broker the results of your Advance  Application, reasons for the denial of your Advance  Application, and information regarding the performance of your Libertas Funding LLC Advance . You may request paper copies of the Application Agreement and/or Privacy Policy from Libertas Funding LLC. If you are the sole owner applying for credit on behalf of your business and are relying on your own income or assets as a guarantor and not the income or assets of another person, complete Owner Information (1) and omit Owner Information (2).
If this is an application for joint owners applying for credit on behalf of your business, complete Owner Information (1) and (2).  Date: Intended Use of Funds: Agent’s Name: E-mail Address: Direct Phone: Fax Number