Primacy Rate Capital

Preliminary Application

Direct: 833-533-1269

Financials

Ownership Information

Second Officer

Main Owner

Main Owner

Signature

Second Owner

Second Owner

Signature

Terms & Conditions: The Merchant and business Owner(s) identified on this application (individually, the “Applicant”) each represent, acknowledges and agrees that (1) all information and documents provided to Capital Primacy Ratecapital.com, represent a true, accurate and complete discription of business and applicant. (2) By submitting this application Applicant authorises AEM and/or it’s funding partners to request, obtain and receive any investigative reports, credit reports, statements of creditors or financial institutions, verification of information or other information deemed necessary to evaluate Applicant. (3) Applicant waives and releases AEM from any claims arrising from the release of and/or the receipt of information relating to applicants request for business financing. (4) Owner/Applicant represents that he or she are authorised to sign this form on behalf of the business and agree to receive all forms of communication (calls, email text, other) from AEM and it’s agents.