Onboard – TRAILD

1General Info

2Company Info

3Requested Service

4Bank Info

5Ownership Info

6Authority

Comments

This field is for validation purposes and should be left unchanged.

Please read the following information before completing this application(“Application”). By signing below, you (the “Company” identified below, which is also referred to as “Customer”) acknowledge, agree, and certify that: (i) all information below is complete and accurate; (ii) you authorize Priority Technology Holdings, Inc. and its subsidiaries, including Priority Commercial Payments, LLC (collectively, “Priority” or “we”), to check with credit reporting agencies, credit references, and other sources we deem appropriate in investigating the information given; (iii) the terms of use of the account and/or card(s) will be governed by the Priority Commercial Payments General Terms and Conditions (the “Terms”) made available to you and incorporated by this reference; (iv) the individual signing below is either a proprietor, general partner, or officer of the Company with authority to enter into the Agreement and to bind the Company; (v) you will provide financial statements for the last two (2) years if requested; and (vi) Priority may review the personal credit of the individual who signs the Application if this Application is for a partnership or a proprietorship to make a credit decision, and a consumer report of such individual may be obtained. Direct inquiries of employers and businesses where such individual maintains accounts may also be made. If you fail to meet your obligations under the Agreement, Priority may report your liability for and the status of the account to credit bureaus and others who may lawfully receive such information. As used herein, the Terms and the Application shall collectively be referred to as the “Agreement.”

Company understands that Priority may require a guarantee, letter of credit, surety bond, or other acceptable form of security in order for Company to receive credit. Company also understands that credit on this account, once approved, will be extended by Priority and there is no binding contract until Priority approves Company’s application for credit and the Agreement is executed.

Part I – Customer General Information

Company Name*

Parent Company (if subsidary)

Tax ID*

US style tax identification number. (##-#######)

Please note that a PO Box cannot be accepted

Physical Address*

Street Address City State ZIP Code

Billing Address*

Same as Address

Street Address City State ZIP Code

Part IV – Ownership and Principals Information

Complete all sections that apply. Priority reserves the right to request additional information from Customer, including documentary information needed to identify the Customer or other information needed to review the Application, such as financial statements.

Section 1 – Corporations and Limited Liability Companies

Control Person/Title (CEO, CFO, Controller, etc.)*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Social Security Number or Tax ID*

Percent of Ownership (if any)

Driver’s License Number*

Date of Issuance*

Date of Birth*

Section 2 – Non-Public Corporations, Limited Liability Companies, Partnerships, and Sole Proprietorships Note:

Note: For purposes of this Application, a non-public entity is one that does not have its stock listed on the New York Stock Exchange, NASDAQ, or other stock exchanges in the United States. The Customer must include ownership information for any individual with 25% or more ownership interest, directly or indirectly. Please add an additional sheet with the same items if the space provided below is insufficient. Priority may also ask to see a copy of a driver’s license or other identifying document for each beneficial owner or the control person listed on this form. If an owner is a business entity, do not complete Driver’s License Number, Date of Issuance, or Date of Birth. If a listed owner is an entity, please provide, on a separate sheet, the same information for the ultimate, individual beneficial owners of such entity.

Check the box if Customer is a publicly traded company or does not have any individual with 25% or more ownership interest, directly or indirectly; then complete the “Control Person” section.

This field is hidden when viewing the form

Owner 1

OWNER #1

Name of Individual or Business Entity*

Address (No PO Boxes)*

Street Address City State ZIP Code

Social Security Number or Tax ID*

Percent of Ownership*

Please enter a number from .1 to 100.

Driver’s License Number*

Date of Issuance*

Date of Birth*

This field is hidden when viewing the form

Owner 2

OWNER #2

Name of Individual or Business Entity

Address (No PO Boxes)

Street Address City State ZIP Code

Social Security Number or Tax ID

Percent of Ownership

Please enter a number from .1 to 100.

Driver’s License Number

Date of Issuance

Date of Birth

This field is hidden when viewing the form

Owner 3

OWNER #3

Name of Individual or Business Entity

Address (No PO Boxes)

Street Address City State ZIP Code

Social Security Number or Tax ID

Percent of Ownership

Please enter a number from .1 to 100.

Driver’s License Number

Date of Issuance

Date of Birth

This field is hidden when viewing the form

Owner 4

OWNER #4

Name of Individual or Business Entity

Address (No PO Boxes)

Street Address City State ZIP Code

Social Security Number or Tax ID

Percent of Ownership

Please enter a number from .1 to 100.

Driver’s License Number

Date of Issuance

Date of Birth

Part I – Customer General Information

Part II – Requested Services, Billing and Payment Terms

Part III – Bank Information (To be used for payment via ACH Debit initiated by Priority)

Part IV – Ownership and Principals Information

Owner 1

Owner 2

Owner 3

Owner 4

Part V – Duty to Update Information; Authority