Card Terminal Application Form Leave this field blank Intermediary / Broker details Registered Broker only Broker Full Name (optional) Mobile (optional) Email (optional) Business Details Correct Information Require to obtain better Deal Applicant Business Name Trading as (if different) (optional) Business Address & Post Code Business Type LTD Name (optional) LTD Number (optional) How long you trading Bank With Total Monthly Sales £ Yearly Sales £ Total Card Sales £ (Monthly) Applicants Details Must be the Beneficiary Applicant 1 Full Name Applicant 2 Full Name (optional) Applicant 1 (DOB) Applicant 2 (DOB) (optional) Applicant 1 Mobile Applicant 2 Mobile (optional) Applicant 1 Email Applicant 2 Email (optional) Applicant 1 Home Address Applicant 2 Home Address (optional) How Long you living in this address Applicant 1 How Long you living in this address (optional) Applicant 2 More then one business information (optional) Terminal Type Desktop Desktop with Table top Wifi Sim Bluetooth If you want Loan Subject to underwriting Loan Amount Max – Min (optional) Term Max – Min (optional) Credit Score (optional) Reason for Funding (optional) GENERAL AUTHORIZATION I/We (Business owner(s)/Principal(s)) hereby authorise the release of any and all information pertaining to my/our business known as above , as requested by BusinessXbridge ltd. or any of their affiliates, agents, assigns, representatives, in connection with my/our application. This General Authorisation also serves as instruction to any person to release the requested information, including but not limited to: current or deposit accounts, merchant accounts, payment cards processing accounts, credit references/verications, payment history, balance, etc. The undersigned hereby give express consent to BusinessXbridge ltd. to obtain and use non-business consumer credit reports on the undersigned in order to further evaluate the undersigned as principal(s), member(s), partner(s), proprietor(s) and/or guarantor(s) and to obtain and use business information from, but not limited to, credit report bureaus, Dun & Bradstreet or its equivalent, public records, Companies House lings, banks, nancial institutions, landlords, vendors, suppliers, etc. The undersigned hereby give my (our) express consent to BusinessXbride ltd. to transfer my (our) personal data outside of the European Economic Area, specically to the USA in strict compliance with the principles of the Data Protection Act and the EU Data Protection Directive. A photocopy or facsimile of this authorisation shall be deemed to be the equivalent of an original. By signing below I/we attest that the information submitted in the application is correct to the best of my/our knowledge and has been submitted voluntarily. Checklist (optional) Latest Business Bank Statement / Void Cheque Proof of Business Proof of ID Passport copy Submit