Connect 2 Funding Merchant Application

Merchant Application
CONNECT 2 FUNDING, LLC
Questions emailed to: info@connect2fundingus.com

General Background: Merchant Information
Paid Search
Type of Entity (check one)*

CorporationLimited Liability CompanyPartnershipLimited PartnershipLimited Liability PartnershipSole Proprietorship
Merchant's Legal Name*
D/B/A*
Federal ID (or SS# for Sole Proprietorship)*
Address*

Physical Address

Street Address Line 2

City, State, ZpState / Province

Postal / Zip Code
Business Phone*
State of Incorporation/Organization*
Business Type: Product/Service Sold*
Date Business Started*

MonthDayYear
Date
Length of Ownership*
Use of Proceeds*
Web Address*
Business Email*
example@example.com
Amount Requested*
Merchant Ownership: Owner No. 1 Percentage (blanks*% of Ownership)
Name*
Sodal Security Number*
Date of Birth*

MonthDayYear
Date
Position*
Driver's License # & State*
Home Phone Number*
Cell Phone #*
Personal Email Address*
Address*

Residence Address

Street Address Line 2

City, State, ZpState / Province

Postal / Zip Code
Merchant Ownership Information: Owner No. 2 Percentage ( blanks%) of Ownership
Name
Social Security Number
Date Birth

MonthDayYear
Date
Position
Driver's License # & State
Home Phone Number
Cell Phone Number
Personal Email Address
Address

Residence Address

Street Address Line 2

City. State, ZpState / Province

Postal / Zip Code
Sales & Credit Card Processing Information
Avg. Gross Monthly Volume (Cash, Checks, Credit Cards)*
Credit Card Processor*
Phone Number*
Funding Information:
Do you have an open loan or merchant cash advance balance?*

YesNo
If yes, company and current balance
Have you used a loan or merchant cash advance program before?*

YesNo
If yes, company:
Is there an outstanding loan to a previous business owner?*

YesNo
If yes, monthly payment & term?
Any state/federal tax liens against owner?*

YesNo
If yes, details:
Have you or business ever declared bankruptcy?*

YesNo
If yes, details:
Are any suits or judgments pending?*

YesNo
If yes, details:
Please Upload Bank Statements from the Last Three Months*

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Cancelof
Business Property Information
Own / Lease*
Lease Start Date*

MonthDayYear
Date
Lease Term*
Monthly Rent/Mtg*
Square Footage (approx)*
Landlord/Mortgage Company*
Contact Name*
Phone Number*
By signing below, each of the above listed Business Owner(s)/Officer(s)/Principal(s) and Business (individually and collectively, “You”) certify that all information and documents submitted in
connection with this Funding Application ("Application") are accurate, true, correct and complete; and that You will immediately notify Connect 2 Funding, LLC or any of its representatives,
successors, assigns, designees, agents, partners or affiliates ("Recipients") of any change in such information or financial condition. You acknowledge that any false statements may be considered
fraud. You acknowledge that the Recipients are relying on the information You provide. You further authorize Connect 2 Funding, LLC and each of the Recipients that may be involved with or acquire
commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions (collectively, “Transactions”) to obtain consumer or personal,
business and investigative reports and other information about You, including, but not limited to credit card processor statements and bank statements, from one or more consumer reporting
agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, financial institutions, creditors and other third parties. You authorize Recipients to receive relevant
information regarding the commercial lease for the above- referenced premises from our leasing company and/or agent. You also authorize Connect 2 Funding, LLC to transmit this Application, along
with any of the foregoing information obtained in connection with this Application, to any or all of the Recipients for the foregoing purposes. A photocopy of the Application will be deemed acceptable
for release of credit and/or investigatory information.
Signature #1*

Clear
Date*

MonthDayYear
Date
Signature #2*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Merchant Application

CONNECT 2 FUNDING, LLC