Live Stores Financing…

                                                Live Stores Financing Application

                                                           BUSNINESS INFORMATION
Business Name:                                                                                           Federal Tax ID Number:
Address:                                                                                                 City:
State:         Zip:                                         Phone:                                       Fax:
Proprietorship                         Corporation               LLC                      Time In Business Under Current Ownership:
Industry:
Contact Name:                                                                             Email Address:

                                                            PRINCIPAL INFORMATION
Principal Name:                                                         Title:                                                      Percentage of Ownership:
Soc Sec #                                                               Address:
City:                                                                   State:                        Zip:                          Phone:
Principal Name:                                                         Title:                                                      Percentage of Ownership:
Soc Sec #                                                               Address:
City:                                                                   State:                        Zip:                          Phone:

                                                        TRANSACTION INFORMATION
Equipment Cost:                                                         Term:                                                 Purchase Option:
Payment Amount:                                                         Advance Payments:                                     Security Deposit:             0.00
Equipment Description: New                                  Used
Vendor:   Live Stores                                       Vendor Contact:               Jan Platovsky                          Phone:         (760)444-8675

                                                                  BANK INFORMATION
Bank:                                                                Branch:                                                        Phone:
Account Number:                                                      Contact:                                                       Fax:

                                                    TRADE / SUPPLIER REFERENCES
Trade:                                                       Contact:                                                     Phone:
Trade:                                                       Contact:                                                     Phone:
Trade/Landlord:                                              Contact:                                                     Phone:
By signing below, each undersigned individual provides written instruction to Bach Business Credit or its designee (and any assignee or potential assignee thereof)
authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application
of the credit applicant and subsequently for the purposes of update renewal or extension of such credit and for reviewing or collecting the resulting account. A photocopy of
facsimile of this authorization shall be valid as original.


Applicant Signature:                                                                                                                Date:
Applicant Signature:                                                                                                                Date:



                                                   Please complete and fax to: (949)222-0277


               1340 Reynolds Avenue, Suite 103 · Irvine, CA 92614 · Phone: 949-222-2241 ·Fax: 949-222-0277
                                              www.bachbusinesscredit.com