STEER FINANCIAL: VERIFICATION FORM

VERIFICATION FORM

BUSINESS INFORMATION
Questions about working capital or equipment financing? Please contact our finance experts:

858.704.2444 or via email at credit@steerfinancial.com
What type of business loan are you applying for?*

Working Capital LoanEquipment Financing
Funding Specialist:
Legal Business Name*
Doing Business As (DBA) Name*
Legal Entity Type*
Federal Tax ID*
Business Start Date (MM/YYYY)*

MonthDayYear
Date
State of Incorporation
Business Industry*
Business Phone Number*
Physical Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Rent or Mortgage/Owned*
Monthly Mortgage/Rent $
FINANCIAL INFORMATION
Amount Requested*
Gross Annual Sales $*
Use of Capital*
Do you currently have any open loans*
Current Balance(s) $
Name of Lenders(s)
EQUIPMENT DESCRIPTION

ONLY FILL OUT IF APPLYING FOR EQUIPMENT FINANCING
Vendor Name
Equipment Cost $
Equipment Year
Equipment Description
Term Requested
Vendor Contact Information
Equipment Vendor Quote or Invoice

Cancelof
OWNER INFORMATION

OWNER/PRINCIPLE #1
Name Owner #1*

First NameLast Name
Date of Birth Owner #1*

MonthDayYear
Date
Social Security # Owner #1*
% of Ownership Owner #1*
Phone Number Owner #1*
Home Address Owner #1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Owner #1*
example@example.com
OWNER/PRINCIPLE #2
Name Owner #2

First NameLast Name
Date of Birth Owner #2

MonthDayYear
Date
Social Security # Owner #2
% of Ownership Owner #2
Phone Number Owner #2
Home Address Owner #2

Street Address

Street Address Line 2

CityState

Zip Code
Email Owner #2
example@example.com
Please submit the last 3 months of business bank statements or any other corresponding files.

Cancelof
AUTHORIZATION
FORM PROCESSING FEE
{name} hereby authorizes STEER FINANCIAL to charge bank debit or credit card account the indicated amount of $495.00 to process file. In the case of a payment being rejected for Non-Sufficient Funds (NSF) I understand that STEER FINANCIAL may at its discretion attempt to process the charge again within 30 days and agree to an additional $35.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of payment transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account or credit card and will not dispute this transaction with my bank or financial institution; so long as the transactions correspond to the terms indicated in this form.

Processing fee of $495.00 will be automatically charged upon processing of the file.
Name*

First NameLast Name
Credit / Debit Card #*
CVV*
Expiration Date*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Verification Form Authorization
The above listed business and business wners/officers/members/partners (individually and collectively, an "Applicant") authorizes Steer Financial LLC and each of its successors, assignees, affiliates, and designees (collectively, "Recipients") that may be involved with or acquire commercial loans having daily repayment features representatives, or purchases of future receivables including Merchant Cash Advance transactions, equipment financing, working capital, including without limitation the application therefor (collectively, "Transactions") to obtain consumer or personal business, and to investigate reports and other information about Applicant. Recipients are authorized to request and receive any investigative reports, verification of information, including without limitation credit card processing statements, statements from creditors or financial institutions, credit reports from one or more consumer reporting agencies, or any other information that Recipients deems necessary. Applicant authorizes Recipients to submit or transmit this application form, along with any of the foregoing information obtained in connection with this application to any or all of the Recipients for the foregoing purposes of obtaining credit. Applicant also waives and releases any claims against Recipients, any information providers, or third parties arising from any act or omission relation to the requesting, receiving, or release of information. You may opt out of receiving communications of your choice from Steer Financial as provided in our Privacy Policy.

Applicant certifies by signing below that all information and documents provided to Steer Financial LLC are true, accurate, and complete. Applicant will immediately notify Recipients of any change in such information or financial conditions.
Owner/Principle #1 Signature*

Clear
Date

MonthDayYear
Date
Owner/Principle #2 Signature

Clear
Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

VERIFICATION FORM

FINANCIAL INFORMATION

EQUIPMENT DESCRIPTION

OWNER INFORMATION

AUTHORIZATION

FORM PROCESSING FEE

Verification Form Authorization