A. BUSINESS INFORMATION


















    B. OWNERSHIP
    *Must Have at Least 67% Ownership











    C. BUSINESS PROFILE

    D. CASH ADVANCE – LOAN QUESTIONS









    E. SIGNATURE

    By signing below, the Merchant and its owners/principals:(1) certify that all information and documents submitted in connection with this application are true, correct, and complete; and (2) authorize Norita Money Consultants, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties in order to verify any information provided on the application.