Credit & Information Authorization

CREDIT & INFORMATION AUTHORIZATION

Merchant Bloom, LLC
54 State Street, Suite 804 #15109, Albany, NY 12207

Your sensitive information (such as DOB and SSN) is securely stored and used only for underwriting and verification purposes.

By signing below, I, the undersigned Owner/Officer, hereby authorize:

1. Merchant Bloom, LLC, to obtain business and/or personal credit reports from any credit bureau.
2. Merchant Bloom to verify bank accounts, balances, statements, and historical activity.
3. Merchant Bloom to contact my bank, processor, accountant, landlord, and trade references.
4. Merchant Bloom to share my information with its funding partners strictly for the purpose of evaluating financing.
5. Merchant Bloom to use electronic signatures and electronic communications in place of paper documents.
6. Merchant Bloom to retain my information for regulatory and underwriting purposes.

I certify that the information I provided is true, correct, and complete.

Signature: ________________________________________

Name: _______________________________________
Title: _____________________________________
Business Name: ____________________________
Date: __________________________________

By clicking “Submit,” you:

• Certify that all information provided is true and complete
• Authorize Merchant Bloom to obtain business and/or personal credit reports
• Authorize secure bank verification
• Authorize contact with references, banks, and processors
• Consent to electronic signatures and electronic communication
• Agree to the Privacy Policy and Terms of Use
• Consent to receive calls and SMS messages regarding this application; message/data rates may apply

This authorization is consistent with all related application documents.