Funding Request and Advance Certificate

CARE CASH GLOBAL (“CCG”) — California Finance Lender & Broker, DFPI License No. 60DBO-168236, NMLS Company ID 2353336

Facility Number *

Borrower *

Request Date *

Advance Request

Eligible Accounts Receivable ($)

Advance Rate

Borrowing Base ($)

Current Outstanding Balance ($)

Available Credit ($)

Borrower certifies that:

Drawn Signature (optional)

Authorized Representative *

Title *

Typed Electronic Signature (Full Legal Name) *

Date *

I certify the information above is true and accurate, and that I am authorized to submit this Funding Request on behalf of the Borrower.

CCG Approval (Approved Amount, Approved By, Title, Date, Funding Date) will be completed by Care Cash Global upon review.