Blockchain Merchant Application

Business Information
Signature(s)

Client authorizes Provider and their partners to investigate the references, statements and other data contained herein and to obtain additional information from credit bureaus and other lawful sources, including persons and companies named in this Merchant Application. Client authorizes Provider and their partners (a) to procure information from any consumer reporting agency bearing his / her personal credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, and (b) to contact all previous employers, personal references and educational institutions. Each of the undersigned authorizes us and our partners to provide amongst each other the information contained in this Merchant Application and Agreement and any information received from all references, including banks and consumer reporting agencies. It is our policy to obtain certain information in order to verify your identity while processing your account application. By signing below, I represent that I have read, and I am authorized to sign and submit this application for the above entity which agrees to be bound by the Merchant Agreement (“Agreement”), and that all information provided herein is true, complete and accurate. I authorize Provider to verify the information in this application and receive and exchange information about me personally, including by requesting reports from consumer reporting agencies, and disclose such information to their agent, subcontractors, partners and other parties for any purpose permitted by law. I authorize and direct Provider, and their partners to inform me directly, or through the entity above, of reports about me that they have requested from consumer reporting agencies. Such information will include the name and address of the agency furnishing the report. You further acknowledge and agree that you will not use your merchant account and /or the Services for illegal transactions, for example, those prohibited by the Unlawful Internet Gambling Enforcement Act, 31 U.S.C. Section 5361 et seq, as may be amended from time to time.

Client certifies, under penalties of perjury, that the federal taxpayer identification number and corresponding filing name provided herein are correct. Client agrees to all the terms of this Merchant Application and Agreement. This Merchant Application and Agreement shall not take effect until Client has been approved and this Agreement has been accepted by Provider

Personal Guarantee: The undersigned guarantees to Provider the performance of this Agreement, and any addendum thereto by Client, and in the event of default, hereby waives Notice of Default and agrees to indemnify the other parties, including payment of all sums due and owing and costs associated with enforcement of the terms thereof. Provider shall n o t be required to first proceed against Client or enforce any other remedy before proceeding against the undersigned individual. This is a continuing guarantee and shall not be discharged or affected by the death of the undersigned and shall bind the heirs, administrators, representatives and assigns and be enforced by or for the benefit of any successor of Provider . The term of this guarantee shall be for the duration of the Merchant Processing Application and Agreement and any addendum thereto, and shall guarantee all obligations which may arise or occur in connection with my activities during the term thereof, though enforcement may be sought subsequent to any termination.

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