Business Loan Application

Business Loan Application
Merchant Cash Advance
E-MAIL TO
E-MAIL TO
example@example.com
Company Information
Company Information
Legal Company Name (& DBA)
Website
Industry
Incorporation State
Tax ID
Legal Entity:
Legal Entity:
Legal Entity:
Address

Business Address

Street Address Line 2

CityState

Zip
Zip
Business Start Date

MonthDayYear
Date
Business Telephone #:
Average Monthly Revenue
Average Monthly Revenue
Monthly Credit Card Processing:
Requested Financing Amount
Requested Financing Amount
Use of Funds:
Existing business loan/advance? Yes No
Existing business loan/advance? Yes No
If yes, list the loan balances: $
Do you Own or Rent Location?
Monthly Rent/Mortgage:
Landlord/Bank Name
Landlord/Bank Name
Landlord Phone #:
Business Owner Information (1)
Business Owner Information (2)
Full Name
Full Name
% Ownership
% Ownership
City
Address

Home Address

Street Address Line 2

CityState / Province

Zip
State
Zip
City
State
Zip
Cell Phone #
Format: (000) 000-0000.
Cell Phone #
Format: (000) 000-0000.
Credit Score (Estimate)
Credit Score (Estimate)
Social Security No
Social Security No
Date of Birth

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
E-mail Address
example@example.com
E-mail Address
example@example.com
The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to (“Company”) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Company of any change in such information or financial condition, (3) Applicant authorizes Company to disclose all information and documents that Company may obtain including credit reports to other persons or entities (collectively, “Assignees”) that may be involved with or acquire commercial loans or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) and each assignee is authorized to use such information and documents and share such information and documents with other Assignees, in connection with potential Transactions, (4) Each Assignee will rely upon the accuracy and completeness of such information and documents (5) Company, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) Each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.
Date (1)

MonthDayYear
Date
Date (1)

MonthDayYear
Date
Date (2)

MonthDayYear
Date
Date (2)

MonthDayYear
Date
Should be Empty:

Business Telephone #:

Monthly Credit Card Processing:

Use of Funds:

Monthly Rent/Mortgage:

Landlord Phone #:

Business Owner Information (1)

Business Owner Information (2)