All Information Contained Herein Shall Be Considered Confidential:

Type of tax Amount in Arrears or 'nil' Arrangements to repay
Payroll (source deductions) $
Income $
G.S.T/Federal $
P.S.T/State $
Workers Compensation $
Other $

Principals of the Company

The foregoing information is true and correct to the best of my knowledge and is given to induce Express Business Funding and The EBF Group Ltd. to consider entering into a factoring agreement with this company. I hereby authorize The EBF Group Ltd. or its agents to verify and investigate any or all of the foregoing statements, including but not limited to my/our credit worthiness and financial responsibility, in any way they may choose. I/We grant The EBF Group Ltd. the right to procure any and all credit reports pertaining to any party listed in this application, including, but not limited to, all principals of the applicant company.