Monera Funding Application

Business Information
Business Legal Name *
Business Legal Name (Must Match Legal Filing)
Business D/B/A *
Business Phone Number *
Please enter a valid phone number.
Business Start Date *

Month Day Year
Date
Business Address *
Street, City, State, Zip Code
Federal Tax ID
Industry/Product/Service
Ownership Information
Owner/Officer #1 *

First Name Last Name
Home Address *
Street, City, State, Zip Code
Phone Number *
Please enter a valid phone number.
Ownership% *
Date Of Birth *

Month Day Year
Date
SSN# *
Email *
example@example.com
Owner/Officer #2

First Name Last Name
Home Address
Street, City, State, Zip Code
Phone Number
Please enter a valid phone number.
Ownership %
Date Of Birth

Month Day Year
Date
SSN#
Email
example@example.com
Terms & Conditions: The Merchant and business Owner(s) identified on this application (individually, the "Applicant") each represent, acknowledges and agrees that (1) all information and documents provided to Monera Capital Group LLC, represent a true, accurate and complete description of business and applicant. (2) By submitting this application Applicant authorizes Monera Capital Group LLC and/or it's funding partners to request, obtain and receive any investigative reports, credit reports, statements of creditors or financial institutions, verification of information or other information deemed necessary to evaluate Applicant. (3) Applicant waives and releases Monera Capital Group LLC from any claims arising from the release of and/or the receipt of information relating to applicants request for business financing. (4) Owner/Applicant represents that he or she are authorized to sign this form on behalf of the business and agree to receive all forms of communication (calls, email text, other) from Monera Capital Group LLC and it's agents.
Application Signature
Owner #1 *

First Name Last Name
Signature *

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Owner #2

First Name Last Name
Signature

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Business Information

Ownership Information

Application Signature