Basic Info
Step: 1 of 5
Business Name
*
Business Owner Name
*
First Name
Last Name
Email
*
Phone Number
*
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Business Info
Step: 2 of 5
EIN / Federal Tax ID
*
Legal Entity
*
Corporation
LLC
Partnership
Sole Proprietor
Date
*
-
Month
-
Day
Year
State of Incorporation
*
Please Select
Alabama
Alaska
Arizona
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Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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Nevada
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New Mexico
New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
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Wisconsin
Wyoming
Industry Type
Please Select
Accounting / Tax / Finance
Agriculture
Appraisal
Architecture
Auto Repair
Auto Sales
Bail Bonds
Bakery
Bar / Pub
Beauty Supplies
Cabinetry
Car Rentals
Car Wash
Carpentry
Catering
Child Care Services
Cleaning Services
Construction - Commercial
Construction - Excavating
Construction - Residential
Consulting
Convenience Store
Counseling
Distributor
Driving School
Dry Cleaners
Ecommerce
Education
Electrician
Electronic Repair
Electronics - Commercial
Electronics - Consumer
Energy
Engraving / Signs / Lights
Entertainment
Event Promotions
Farm / Farming Supply
Flooring
Florist
Funeral Services
Gas
Graphic Design
Grocery / Market
Health Products/Services
Hotel / Hospitality
HVAC
Import / Export
Industrial Services
Insurance
IT Services
Jewelry
Landscaping
Laundromat
Aerospace
Law Firm
Legal
Locksmith
Logging
Management Company
Manufacturing
Marketing
Medical
Mortgage Brokers
Moving & Storage
Nursing Home / Rehabilitation / Hospice
Other
Painting Services
Pawn Shop
Pest Control
Pet Shop / Care
Photography
Physical Therapy
Plumbing
Printer / Digital Press
Real Estate
Recycling
Restaurant
Restoration
Retail
Roofing
Sales/services
Salon
Security
Software
Spa & Health Club
Staffing Services
Telecommunications
Towing
Transportation/Logistics
Travel
Trucking
Upholstery
Vacation Home Rental
Veterinary
Wholesale
Fast Food
Number of Employees
Average Monthly Revenue
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Business Address
Step: 3 of 5
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Location is
Owned
Rented
Business Location Type
Home Based
Office
Retail
Type option 4
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Additional Owner Info
Step: 4 of 5
Social Security Number
*
Date
-
Month
-
Day
Year
Date
Owner Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Financial Info
Please upload three previous months business bank statements
Recent Bank Statement 1
*
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Recent Bank Statement 2
*
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Recent Bank Statement 3
*
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By signing below, you (on behalf of yourself and each individual or entity you are submitting this application, including each of the owners/principals of your business): (1) authorize Fox Capital Group Inc. (“FCG”), its agents, partners, and outside funding partners to investigate your business’s and each of its owners/principals’ business and personal financial and credit history, including by making soft or hard credit inquires and reviewing credit reports and any other information regarding the same from third parties, to verify any information provided with this application; (2) certify that all information and documents submitted in connection with this application is true, correct and complete; (3) confirm that you are authorized and have taken all necessary actions to obtain consent to provide the requested business and personal financial and documents submitted herewith; (4) authorize FCG to use all of the foregoing information and documents for the purpose of obtaining approval for merchant cash advance funding; (5) acknowledge that pre-approval for funding does not constitute a funding commitment; (6) acknowledge that telephone calls to and from FCG may be recorded; and (7) understand that you may opt out of receiving communications of your choice from FCG.
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