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Legal Company Name*

Doing Business As(DBA)*

Physical Address*

Company Type / Industry*

Business Inception Date*

Legal Entity*

City*

State*

State of Incorporation*

Legal Entity*

Do you have a business account?*

Zip Code*

Rent or Own*

Required For Recommended Loan Amount

Gross Annual Business Revenue*

Loan Amount Requested*

Average Bank Balance*

Desired Loan Term*

Number Of Deposits Per Month*

Owner Information

First Name*

Last Name*

Email*

Cell Phone*

Business Address (No P.O. Box)*

% Ownership*

First Name*

Last Name*

Email*

Cell Phone*

Business Address (No P.O. Box)*

% Ownership*

By signing and submitting this application to "Medallion Funds LLC" and it's lender partners also known as ("MF LLC, US, WE") this business loan application ("Loan Application")for the company identified in the company information section above ("Company"), the person signing this application, ("you, Your") certify that (i) you have the authority to apply, on behalf of the company, for a business loan from "Medallion Funds LLC", (ii) all information provided in this application and any other supporting documents are true, exact and complete. We will be notified of any changes to this information should the change occur, (iii) you understand that to help the govenment fight the funding of terrorism and money laundering activities, federal laws requires all financial institution to obtain, verify, and record information that identifies each person and entity who is applying for credit, and therefore, when your company applies for credit, we will ask for your name, address, date of birth and other information that would allow us to identify you and your company, (iv) you agree to this application agreement to ("MF LLC") either in a manual written format and or on line, (v) You would consent to receiving calls and messages from us or affliated partnership including from time to time automated calls for marketing purpose, from 'us" or "our" representatives, agents, then, you would consent that no acquisition of credit and services is continject upon such a consent. Additionally you would agree that a telephone call may be recorded for the purpose of training our staff, (vi) you would acknowledge that you have read and understood "Medallion Funds LLC" privacy policies on "our" website and you understand that you may opt out of receiving comunications from "Medallion Funds LLC" as provided in the privacy policy. You understand and agree that "Medallion Funds LLC", its representatives , agents, or assignees are authorized by you and the company to order and conduct background checks and other investigative reports on you and the company, including credit bureau agencies and reports from other sources and to contact third parties, all in furtherance of evaluating this loan. Furtheremore, "we" have authority for the foregoing in connection with any update, renewal or extension of credit or loans to the company from "us". You would agree that in accordance with "our" privacy policy, we may provide credit and other information provided in this loan application to third parties who may use the information for a lawful purpose, including and not limited to offering of our products and services to the company. You may request paper copies of the application and OR "Privacy Policies" from "Medallion Funds LLC". Depending on the state in which your company is located and or other attributes of the loan, your business loan may be issued by "OUR OTHER PARTNER BANK" Member FDIC. Your loan agreement will indentify loan issuer prior to your signing.

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