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MERCHANT PROCESSING APPLICATION

Business Information

Legal Name:	Phone #:	Email Address:
DBA:	Cell Phone #:	Industry:
Federal Tax ID #:	State of Inc:	Entity Type:
Business Start Date:		Website:
Address:	City:	State:	Zip Code:

Yearly Sales Volume:	ADB:	Average Ticket Size:
Monthly Deposit Volume:	Credit Score:	Highest Ticket Size:

Processing Information

Do you currently process credit cards?	Current Processor	Monthly CC Sales $	# of CC Transactions Per Month	Equipment Type	Number of Employees

	IT/Tech Person First Name:	IT/Tech Person Last Name:	IT/Tech Phone: esiggravity formid="36" field_id="183" display="value" ]	IT Tech Email:

Owner/Officer 1 Owner/Officer 2

First Name:		Last Name:	First Name:		Last Name:
Ownership %:		Date of Birth:	Ownership %:		Date of Birth:
SSN#:		Email:	SSN#:		Email:
Street Address:			Street Address:
City:	State:	Zip Code:	City:	State:	Zip Code:
Home Phone:		Cell Phone:	Home Phone:		Cell Phone:

By signing below, each of the above-listed business and business owners/officers/members (individually and collectively, the “Applicant”) certifies that Applicant is authorized to submit this application on behalf of the above-named business. Applicant certifies that all information and documents submitted in connection with this Application are true, correct, and complete and may be relied upon by Joseph Vincent Lustberg, Inc. DBA Upwise Capital and Upwise Capital LLC (“UC”). Applicant authorizes UC to share this application and all supporting documentation with each of its representatives, successors, assignees, affiliates, and designees including third-party lenders (collectively “Assignees”). that may be involved with the acquiring of commercial loans and/or other products. Applicant further authorizes UC and all Assignees to request, receive, and review any investigative or credit reports, including comprehensive business and personal credit histories or hard credit pulls, and any other information regarding the Applicant and its owners and/or principals from third parties deemed necessary by UC or Assignees to verify any information provided on the Application including without limitation credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian, and Equifax, and other credit bureaus, banks, creditors and other third parties. UC shall not disclose information in your credit report to third parties. The applicant also consents to the release, by any credit or financial institution, of any information relating to Applicant, to UC, and each of the Assignees, on its own behalf. The applicant also consents to email and/or text/SMS/fax messages at the phone number(s) provided above, including your wireless number, using an automated telephone dialing system or another similar system for marketing purposes by UC and/or third-party lenders, as well as their respective affiliates or agents acting on their behalf. Furthermore, Applicant hereby waives and releases any claims against UC, all Assignees, and any information-providers arising from any act or omission relating to the requesting, receiving, or release of the information obtained in connection with this application.

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Timestamp

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October 19, 2023 3:54 PM EST

Upwise Merchant Processing Application Uploaded by Sean Lustberg - [email protected] IP 24.193.58.236

MERCHANT PROCESSING APPLICATION

Legal Name:

Phone #:

Email Address:

DBA:

Cell Phone #:

Industry:

Federal Tax ID #:

State of Inc:

Entity Type:

Business Start Date:

Website:

Address:

City:

State:

Zip Code:

Yearly Sales Volume:

ADB:

Average Ticket Size:

Monthly Deposit Volume:

Credit Score:

Highest Ticket Size:

IT/Tech Person First Name:

IT/Tech Person Last Name:

IT/Tech Phone:

esiggravity formid="36" field_id="183" display="value" ]

IT Tech Email:

First Name:

Last Name:

First Name:

Last Name:

Ownership %:

Date of Birth:

Ownership %:

Date of Birth:

SSN#:

Email:

SSN#:

Email:

Street Address:

Street Address:

City:

State:

Zip Code:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Home Phone:

Cell Phone: