The Merchant and the Owner(s)/Officer(s) identified above (individually, an "Applicant") represent, acknowledge and agree that (1) all information and documents provided to the representative (FUNDS), including statements from the credit card processor, is true, accurate and complete. (2) The applicant shall immediately notify FONDOS of any change in said financial condition information, (3) The applicant authorizes FONDOS to disclose all information and documents that the Representative may obtain, including credit reports, to other persons or entities ( collectively, "Assignees") who may engage in or acquire business loans that have daily payment features or future receivables purchases, (6) the Applicant waives and releases any claim against the Recipients and any information providers arising from any act or omission related to the request, receipt or disclosure of information, and (7) each Owner / Official Representative who is authorized to sign this form on behalf of the Merchant. A copy of this authorization may be accepted as the original. The term "Representative" shall mean any financing source seeking to offer, make available, or provide Merchant with access to Merchant loans or cash advances based on said Merchant's future accounts receivable or sales and/or structured with a periodic reimbursement function.