Business Capital Application
Business Name
*
E-mail
*
example@example.com
Phone Number
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Industry Type
*
Federal Tax ID
*
Business start date under current ownership
*
-
Month
-
Day
Year
Date
State of Incorporation or Organization
*
What type of loan are you interested in?
*
Please Select
Business Term Loan
Merchant Cash Advance
Business Line of Credit
SBA Loan
Consolidation
Collateralized Loan
How much capital do you need?
*
Please Select
15k-25k
25k-50k
50k-100k
100k-250k
250k-500k
500k-1m
1m+
How soon do you need funding?
*
Please Select
24-48 Hours
1-2 Weeks
3-4 Weeks
4 Weeks
Do you have any open merchant cash advance or business loan accounts?
*
Yes
No
Lender Name & Balance
Lender Name & Balance
Lender Name & Balance
Merchant/Owner Information
Name
*
First Name
Last Name
Title
*
Ownership Percentage
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN
*
Credit Score
*
Date of Birth
*
-
Month
-
Day
Year
Date
Please Upload The Last 4 Months of Statements
Bank Statement (PDF)
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Bank Statement (PDF)
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Bank Statement (PDF)
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Bank Statement (PDF)
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*
The Company and the undersigned principal owner of the Company identified above (“Applicant”) represent, acknowledge, and agree that (1) all information and documents provided to the funding facilitator, broker, or service provider (“Provider”) are true, accurate, and complete, (2) Applicant will immediately notify Provider of any change in Applicant’s financial condition, (3) Provider is authorized to submit this Application and all supporting documents provided by Applicant to its affiliates, representatives, successors, assigns, designees, agents, partners, and third-party financial institutions for the purpose of considering commercial financing offers to Applicant (collectively, “Recipients”), (4) such Recipients are authorized to request and receive any investigative reports, consumer credit reports, statements from creditors or financial institutions, verifications of information, or any other information that the Recipients deem necessary in considering this Application, (5) the undersigned represents that they are authorized to sign this form on behalf of the Company, and (6) THE COMPANY AND PRINCIPAL CONSENT TO RECEIVE CALLS, TEXT MESSAGES, AND EMAILS FROM PROVIDER AND RECIPIENTS AT THE TELEPHONE NUMBERS AND EMAIL ADDRESSES PROVIDED IN CONNECTION WITH THIS APPLICATION, INCLUDING COMMUNICATIONS MADE USING AUTOMATED TECHNOLOGY OR PRE-RECORDED MESSAGES, WHERE PERMITTED BY LAW. THE COMPANY AND PRINCIPAL UNDERSTAND THAT SUCH CONSENT IS NOT A CONDITION OF APPROVAL OR FUNDING AND THAT THEY MAY REVOKE OR WITHDRAW THIS CONSENT AT ANY TIME BY PROVIDING NOTICE TO PROVIDER OR ANY RECIPIENT, INCLUDING BY REPLYING “STOP” TO A TEXT MESSAGE, USING AN EMAIL UNSUBSCRIBE MECHANISM, OR BY ANY OTHER REASONABLE MEANS OF COMMUNICATION.
Signature
*
Submit
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