APPLICANT BUSINESS INFORMATION

PRIMARY GUARANTOR INFORMATION

SECONDARY GUARANTOR INFORMATION (If Applicable)

By checking this box below, the applicant(s) represent that all information provided with respect to this Application is true and correct. Each principal or personal guarantor listed provides TriQuest Capital (or their assignee or potential assignee) written authorization to obtain from third parties personal credit reports and profiles for the purpose of extending, renewing or updating credit to the applicant(s). The Applicant authorizes their borrowing, banking, depository and trade information to be released to TriQuest Capital by phone or fax. A facsimile, photocopy, or electronically submitted copy shall be as valid as the original subject to the current law.