Office Use Only: Date ______________

BLACK WALLSTREET

Account No. ________________

International

Refd By: _______________

Approved GEO Code: ______________

GEO-LOCATION
SPONSORSHIP APPLICATION
General Information:
Legal Name of Entity/Individual (if any):_____________________________________________
Trade Name:__________________________________________________________________
SSN/EIN #: __________________________Kemetic Tradex Account #:___________________
Applicant Personal Promo Code# _______________________________________________
Office Address:
___________________________________________________________________________
___________________________________________________________________________
City: _______________________ State: ________________ Zip: ______________________
Mailing Address:
___________________________________________________________________________
___________________________________________________________________________
City: _______________________ State: ________________ Zip: ______________________
Phone #: ___________________ Fax #: ________________ Other #: ___________________
Date Established: ________________________________________
Company Structure:
o Corporation Year: _____ State: ________________
o Partnership
o Proprietorship
o Other (Explain):
_________________________________________________________________
Has there been a change of owners in the past year?
Yes No
If yes, explain:
_________________________________________________________________________
_________________________________________________________________________

Initials (_____) Initials(_____)

Office Use Only: Date ______________

BLACK WALLSTREET

Account No. ________________

International

Refd By: _______________

Approved GEO Code: ______________

Has the Company ever changed its name?

Yes [ ] No [ ]
If yes, explain:
_________________________________________________________________________
____________________________________________________________________________
Brief description of the business or primary product:
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________ See Business Plan [ ]
Individual Information #1
All Officers, Directors, Partners, and Principals please complete the following information:
Full Name:
First: __________________________ Middle: ________________ Last: __________________
Home Address: _______________________________________________________
City: _______________________ State: ________________ Zip: ______________________
Phone #: ___________________ Fax #: ________________ Other #: ___________________
Social Security #: ________________________________________
Driver License #: ____________________ State: _________ Expiration Date: ____________
Date of Birth: ________________________ Percentage Ownership: _____________________
Title: _______________________________ Email Address: ___________________________

Initials (_____) Initials(_____)

Office Use Only: Date ______________

Account No. ________________

BLACK WALLSTREET

Refd By: _______________

International

Approved GEO Code: ______________

Individual Information Cont.

All Officers, Directors, Partners, and Principals please complete the following information:
Full Name:
First: ______________________ Middle: ________________ Last: ______________________
Address: _______________________________________________________________
City: _______________________ State: ________________ Zip: ______________________
Phone #: ___________________ Fax #: ________________ Other #: ___________________
Social Security #: ________________________________________
Drivers License #: ____________________ State: _________ Expiration Date: ____________
Date of Birth: _________________________________________________________________
Percentage Ownership: _________________________________________________________
Title: ________________________________________________________________________
Email Address: _______________________________________________________________
Geographic Location Desired:______________________________
GEO Size: _______________________ (i.e.SM401)

No.: ___________________________

Total Amount of Geo-Sponsorship: $_____________________

Minimum Down Payment [ ] yes

[ ] no, Partial Payment

[ ] no, Payment-In-Full

Amount $_______________________
_____ To process your Down Payment Option, simply link to payment link in the Executive
Power Lounge to process your payment along with this application submission.
_____ I am aware that by being an Affiliate to Black Wall Street International does not exempt
my organization from being funded by Spiral Funding.
_____ I am aware that I am eligible to resubmit my application for funding to subsequent
additional funding rounds if I do not receive funding approval from most current
submission.

Initials (_____) Initials(_____)

I am aware that Black Wall Street International will compensate my organization once a month
at the beginning of each month with the prorate percentage of my Geo-Locations performance
(______) initials
*Due to the nature of the program we are hosting, we have found it necessary to adopt a firm NO
REFUND policy on all Group subscriptions and enrollments.

Office Use Only: Date ______________

BLACK WALLSTREET

Account No. ________________

International

Refd By: _______________

Approved GEO Code: ______________

OREGON NOTICE: Under Oregon law, most agreements, promises and commitments made by lender after October 3, 1989, concerning loans and
other credit extensions which are not for personal, family or household purposes or secured solely by the borrowers residence must be in writing,
express consideration and be signed by the lender to be enforceable. Each applicant hereby acknowledges receipt of a copy of this application.
WISCONSIN NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under section 766.59, Wis.
Stats., or court decree under section 766.70, Wis. Stats., adversely affects the interest of the creditor unless the creditor, prior to the time the credit is
granted or an open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse
provision.
WISCONSIN RESIDENTS INSTRUCTIONS FOR INFORMATION TO BE SUPPLIED: If married applicants are applying for joint credit, include all
assets and all liabilities of both spouses. Both spouses must sign this statement. If a married applicant is applying for separate credit or for joint credit
with someone other than his or her spouse, include all marital property and all individual property of the applicant spouse. A married applicant
must in every case identify the liabilities of both spouses.
AUTHORIZATION: Each Business Applicant and each person or entity signing this Application or an Application Addendum Form (Signer) certifies
that all information provided by the Business Applicant and the Signer is true and complete and authorizes Myriad Services Financial to 1) obtain credit
and employment information about the Business Applicant and Signer; 2) obtain credit reports and make any inquiries Myriad Services Financial
considers appropriate in connection with this application or review of this loan account from time to time; 3) make Myriad Services Financials
experience with this loan account and information about this application available to credit bureaus, other Signers or other persons who
have or expect to have financial dealings with the Business Applicant and the Signer; 4) share collection information with Signers other creditors; and
5) disclose account information as required by law. Each Signer acknowledges that additional information may be required in order to make a final
credit decision. Business Applicant also acknowledges receipt of the Equal Credit Disclosures provided with this application.
REQUIRED SIGNERS: All Signers must also be duly authorized to sign on behalf of applicant.
ACKNOWLEDGEMENT: EACH SIGNER ACKNOWLEDGES THAT MYRIAD SERVICES FINANCIAL MAY RELY ON THE STATEMENTS AND
INFORMATION SET FORTH IN THIS APPLICATION AND THAT SUCH STATEMENTS AND INFORMATION MAY BE INCORPORATED BY
REFERENCE IN ANY AGREEMENT ANY OF THE UNDERSIGNED MAY ENTER INTO WITH MYRIAD SERVICES FINANCIAL. EACH OF THE
UNDERSIGNED HEREBY AGREES TO NOTIFY MYRIAD SERVICES FINANCIAL PROMPTLY OF ANY CHANGE IN ANY SUCH STATEMENT OR
INFORMATION. EACH SIGNER HAS READ AND UNDERSTOOD THE TERMS OF THIS APPLICATION, INCLUDING ANY ADDENDUM, AND
REPRESENTS AND WARRANTS THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and
money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens
an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow
us to identify you. We may also ask to see your drivers license or other identifying documents.

X _____________________________________
Authorized Signature Print Name Title

______________________
Date

X_____________________________________
Authorized Signature Print Name Title

______________________
Date

Signature of Guarantors: (Each Shareholder, Partner, or Member owning 25 percent or more interest in the Business Applicant, sign below.)
For married Wisconsin residents: I understand the lender may be required by law to give notice of any credit transaction to my spouse. The credit
applied for, if granted, will be incurred in the interest of my marriage or family.

X _____________________________________
Authorized Signature Print Name Title

______________________
Date

X_____________________________________
Authorized Signature Print Name Title

______________________
Date

Initials (_____) Initials(_____)