The Business and the Business Owner(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Converge CG, LLC are true, accurate and complete, (2) Applicant will immediately notify Converge CG, LLC of any change in such information or financial condition, (3) Applicant authorizes Converge CG, LLC to disclose all personal and/or business information and documents that Converge CG, LLC may obtain, including credit reports and personal information and any information that Applicant may provide to Converge CG, LLC in Applicant’s application(s) for any product, service or program through Converge CG, LLC, to other persons, entities or third-parties that facilitate financing (collectively, “Assignees and Third-Parties”), as follows: (a) to Assignees and Third-Parties that may make, be involved with, or acquire commercial financing programs having daily, weekly, bi-weekly or monthly repayment features, (b) to Assignees and Third-Parties that may be involved with purchases of future receivables including Merchant Cash Advance transactions, and (c) to Assignees and Third-Parties for the purpose of offering Appli- cant our products, services or programs or those of third parties that Converge CG, LLC believes Applicant may find of interest, including, without limitation, equipment finance and/or equipment leasing programs and services (collectively, “Transaction”) and each Assignee and Third-Party is authorized to use such information and documents, and share such information and documents with other Assignees and Third-Parties, in connection with potential Transactions, (4) each Assignee and Third-Party will rely upon the accuracy and completeness or such information and documents, (5) Converge CG, LLC, Assignees, Third-Parties, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release or information, (7) without a requirement of purchase Applicant authorizes Converge CG, LLC to disclose all information and documents that Converge CG, LLC may obtain including credit reports to other persons or entities (collectively “Credit Service Organizations”) that may be able to assist the Applicant in removing or correcting any inaccurate items appearing on the Applicant’s credit report(s), and Applicant further authorizes any Assignees, Third-Parties, Credit Service Organizations, or agents or representatives of Converge CG, LLC to contact Applicant on any telephone number provide by Applicant irrespective of whether such telephone number(s) appear(s) on any “Do Not Call” lists and through the use of SMS text or an autodialed telephone call that may include a pre-recorded message, (8) to the extent allowable by law Applicant may opt out of any of the above stated authorizations by contacting (301) 732-7218 with the understanding that such an opt out may limit the services Converge CG, LLC may provide Applicant and with the further understanding that such an opt out will have no effect whatsoever on any funds owed by the Applicant, (9) each Signatory represents that he or she is authorized to sign this form on behalf of the Applicant and Business Owner(s), (10) Applicant hereby consents and agrees, on behalf of itself, as well as Business Owner(s), that Converge CG, LLC, Assignees, and Third-Parties, including their agents or representatives may contact Applicant and/or Business Owner(s), by email (including, without limitation, adding Applicant and/ or Business Owner(s) to our newsletter mailing list), using information which Applicant and/or Business Owner(s) or their agents, employees or representatives have provided to Converge CG, LLC, or any other information which is publicly available, (11) Applicant hereby consents and agrees to the collection and disclosure of its business and/or personal information, both online and offline, to be disclosed to (i) Converge CG, LLC’s subsidiaries and affiliates; (ii) to contractors, service providers, vendors, and other third parties Converge CG, LLC uses to support its business; (iii) Assignees and Third Parties; (iv) to respond to subpoenas, court orders, legal process, or to establish or exercise Converge CG, LLC’s legal rights or defend against legal claims; (v) to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations involving potential threats to physical safety of any person, violation of Converge CG, LLC’s terms or agreements, or as otherwise required by law; (vi) to a buyer or other successor in the event of a merger, divesture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of Converge CG, LLC’s assets, whether as a going concern or as part of bankruptcy, liquidation, or similar proceeding, in which Applicant’s personal information is among the assets transferred; and/or (vii) for the purposes stated in Converge CG, LLC’s Privacy Policy, and Applicant agrees that any additional use of its information not outlined above or in the Privacy Policy may be disclosed and consented to orally, which oral consent will be treated as if in writing. I understand that this consent is not a condition of purchase.
