FUNDING APPLICATION

FUNDING APPLICATION
How did you hear about Financial Infusion Group?
FUNDING REQUEST
Requested Amount:*
Proposed Collateral:*
Example: Accounts Receivables or Real Estate; Enter "none" if no collateral is available.
How will funds be used for the business?*
Funds needed by:
BUSINESS ENTITY INFORMATION
Legal Business Name:*
Trade Name or Other Business Name:
Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number:*
EIN/Tax ID Number:*
NAICS Code(s):
State your core product or service:*
Year business Established:*
State of Origin/Incorporation:*
Is Business in Good Standing?*

YesNo
Monthly Gross Revenue:*
Type of Business Entity:*

PartnershipLLC - Single-MemberLLC - Multi-MemberCorporationSole ProprietorshipOther
Number of Employees:
Number of Owners:*
Business Email Address:*
example@example.com
Website:

Social Media Presence:

Additional Source of Income?

		If Yes, please provide details:
Yes
No

Is the Business or Business Owner Named as a Defendant in Active Litigation?*

YesNo
If yes, please provide State of Litigation and Case #:*
Type "N/A" if you selected "No"

Banking Relationships:*

Existing Loans:

BUSINESS REFERENCES (i.e. Vendor, Lender, etc.):*

Authorization to Access Consumer Credit File

By signing below, you understand and agree that you are authorizing Financial Infusion Group, LLC, a Maryland limited liability company ("FIG"), its agents, representatives, and/or service providers to obtain your individual consumerreport, including your credit score, and other information, for the purpose of verifying your identity and processing this application for funding.
Funding Application Acknowledgement

By submitting this application, you specifically represent to FIG (the "Funder") and agree and acknowledge that:(1) the information provided in this Funding Application and other requested and required information for the purposes of obtaining funding is true, accurate, and complete as of the date this application is submitted for a credit or funding decision; and (2) the Funder has not made any commitment to approve the Funding Application or make any offer for funding, unless otherwise agreed to in writing.

FUNDING REQUEST