SUPPORTING / SUPPLEMENTAL INFORMATION: Please provide the below information (check off items you are including)

OFFICERS, SHAREHOLDERS, & MANAGEMENT (use additional pages if necessary to list all principles and/or officers) The following undersigned individuals hereby authorize Bridgeport Capital Services, Inc. to obtain credit report(s) and conduct background investigation(s):

Electronic Signatures and Counterparts. This form may be executed by means of (a) an electronic signature that complies with the federal Electronic Signatures in Global and National Commerce Act, state enactments of the Uniform Electronic Transactions Act, or any other relevant and applicable electronic signatures law; (b) an original manual signature; or (c) a faxed, scanned, or photocopied manual signature. Each electronic signature or faxed, scanned, or photocopied manual signature shall for all purposes have the same validity, legal effect, and admissibility in evidence as an original manual signature. Bridgeport reserves the right, in its sole discretion, to accept, deny, or condition acceptance of any electronic signature on this document. This form may be executed in any number of counterparts, each of which shall be deemed to be an original, but such counterparts shall, together, constitute only one instrument. Delivery of an executed counterpart of a signature page of this form will be as effective as delivery of a manually executed counterpart of the form.

I understand this is not an application for credit. The intent of this profile is for Bridgeport Capital Services, Inc. to determine if a relationship between you and us would be mutually beneficial. I certify that the information provided in this profile and the Supplemental Information required is true and correct as of the date of this profile. I authorize all credit, lien, other investigative searches as well as reference checks and any other investigations on the company and its Principals and Officers, and hereby irrevocably release you and hold you harmless from any claim of any kind related to or arising out of any such investigation. Further, I approve and accept financial responsibility to cover any costs you may incur in conducting your investigation. Upon request, you will provide us with an invoice of any costs you have expended on our behalf to conduct your investigation. I appoint you and your assigns as my agent and attorney-in-fact to sign and file UCC financing statements for protecting your security interest under any agreements and transactions relating to our firms. We will promptly notify you of any intended changes in the facts concerning our organization, name, places of business, authorities and other matters presented to you. I understand that any misrepresentations, fraudulent entries, or omissions on this profile and the Supplemental Information may be used for legal action.

SIGNATURE Shareholder/ Owner #1

SIGNATURE Shareholder/ Owner #2

Electronic Signatures and Counterparts. This form may be executed by means of (a) an electronic signature that complies with the federal Electronic Signatures in Global and National Commerce Act, state enactments of the Uniform Electronic Transactions Act, or any other relevant and applicable electronic signatures law; (b) an original manual signature; or (c) a faxed, scanned, or photocopied manual signature. Each electronic signature or faxed, scanned, or photocopied manual signature shall for all purposes have the same validity, legal effect, and admissibility in evidence as an original manual signature. Bridgeport reserves the right, in its sole discretion, to accept, deny, or condition acceptance of any electronic signature on this document. This form may be executed in any number of counterparts, each of which shall be deemed to be an original, but such counterparts shall, together, constitute only one instrument. Delivery of an executed counterpart of a signature page of this form will be as effective as delivery of a manually executed counterpart of the form.