Small Business Finance Prequalification

Merchant Profile

First Owner or Principal's Information

Second Owner or Principal's Information

Additional Information

Type in Signature

By signing below, you certify that (1) you are an authorized owner, principal or decision maker for the business, (2) all information and documents submitted in connection with this application are true, correct and complete; and (3) you authorize Integrated Payment Technologies LLC, its agents, partners, affiliates and lenders to receive credit reports and any other information regarding the Merchant and its owners and principals from third parties, to verify any information provided on the application. You further agree to receive autodialed marketing calls and text messages from or on behalf of Integrated Payment Technologies LLC at any of the phone numbers provided herein and anytime hereafter. You understand that this consent is not a condition of any purchase or funding decision.