B2capform

B2 Account Manager Name:*
CLIENT APPLICATION
Preferred Language*
Your preferred language
Business Legal Name*
Registered with IRS
DBA
Doing Business as
Business address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Phone Number

Area codePhone Number
Email*
example@example.com
Federal Tax ID*
Date Business Started*

MonthDayYear
Date
Type of Business / Industry*
Type of Entity*
Purpose of Advance*
What are some goals you would like us to help your company achieve?*

MarketingCompany growth or expansionReduce spendingIncrease salesNew locationNew equipment
Are you current with your Rent/Mortgage*

YesNo
Do you have any current Tax Liens*

YesNo
Is your Business Seasonal*

YesNo
Which of the following is the most important to you?*

Lowest payments (no matter the dollar amount or cost)Highest dollar amount (no matter the cost or term)Lowest cost (no matter the dollar amount or term)
Best Sales month
Requested amount*
Gross Annual Sales*
Please include any attachments (e.g., logo, mission statement, annual report, etc.) that would help us better understand your company's needs.
Owner/Parter Information
Full Name*
SSN*
Date of Birth*

MonthDayYear
Date
Personal Credit score average*
Ownership %*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Driver's License number
Phone Number

Area CodePhone Number
If there is another owner/partner with 20% or more
Name
SSN
Date of Birth

MonthDayYear
Date
Personal Credit score average
Ownership %
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Driver's License number
Phone Number

Area CodePhone Number
BUSINESS PROPERTY INFORMATION
Business Landlord or Mortgage Bank
Contact name / Cell Phone / Email
Credit Card processor
COMPANY DEBT INFORMATION
Current Cash Advance company (If applicable)*
Original Advance Amount
Current Outstanding Balance
Funded date
Daily/weekly payment?
Funding Type Requested

Consolidation2nd position3rd positionOther
preferred terms
APPLICANT AUTHORIZES B2 CAPITAL SOLUTION PROVIDER,LLC OR ITS ASSIGNS, AGENTS, BANKS, OR FINANCIAL INSTITUTIONS TO OBTAIN AN INVESTIGATIVE OR CONSUMER REPORT FROM A CREDIT BUREAU AND TO INVESTIGATE THE REFERENCES GIVEN OR ANY OTHER STATEMENTS OF DATA OBTAINED FROM APPLICANT AND TO ALLOW ITS LENDER TO FILE APPROPRIATE UCC LIENS WHEN NECESSARY IN ORDER TO SECURE THE FUNDING.
Please verify that you are human*
Upload the last 3 month's bank statements for each business account.
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Signature (1st Owner)*
Signature (2nd Owner)
Should be Empty: