WORKING CAPITAL - APPLICATION FORM

1
What is the legal name of the business?
2
What is the " Doing Business As" (Dba) ?
3
Where is the physical address of the business?
4
What is the business phone number?
5
What is the business owner mobile number?
Please enter a valid phone number.
6
What is the name of the business website?
7
What is the email for the business?
example@example.com
8
What is the legal entity of the business?
Corp
Sole
LLC
Prop
Partnership
9
Which state is the " State of Organization " for the business?
10
What is the Federal (Tax ID) of the business?
11
Which date business started?
Date
Month
Day
Year
12
Which date current ownership started?
Date
Month
Day
Year
13
Do you rent or own the business property?
Rent
Own-Mortgage
Own-Outright
14
What is the monthly rent or mortgage payment?
15
Are you current with rent / mortgage ?
Yes
No
NA
16
What is the landlord's name?
17
What is landlord's phone number?
18
What is the remaining length of lease?
19
What is the complete name of the Owner (1) ?
20
What is the date of birth of Owner (1)?
Date
Month
Day
Year
21
What is the complete home address of Owner (1)?
22
What is the email for Owner (1)?
example@example.com
23
What is the percentage of ownership for Owner (1)?
24
What is the social security number for Owner (1)?
25
What is the complete full name for Owner (2)?Type ("N/A") if not applicable.
26
What is the birth date for Owner (2)?Type ("N/A") if not applicable.
Date
Month
Day
Year
27
What is the home address fo Owner (2)?Type ("N/A") if not applicable.
28
What is the email for Owner (2)?Type ("N/A") if not applicable.
example@example.com
29
What is the percentage of ownership for Owner(2)?Type ("N/A") if not applicable.
30
What is the social security number for Owner (2)? Type ("N/A") if not applicable.
31
What is the business " Industry Description / SIC "?
32
What type of business products or services are sold?
33
What is aprox. the annual business revenue?
34
How many numbers of business accounts?Type (1 or 2) if not applicable.
35
What is aprox. the average daily bank balances?
36
What is aprox. the average monthly sales?
37
What is the average monthly credit card sales?
38
What is the current working capital balance?(if any)Type ("N/A") if not applicable.
39
What is the purpose of funds used for?
40
Are you a party to any existing contractual agreements for which you have received working capital?
YESNO
41
Authorizations: By signing below, each of the above listed business and business owners (individually and collectively, "you") authorize Goldencap, LLC ("GOLDENCAP") and its affiliates, successors, assigns and designees ("Recipients") to obtain consumer, personal and business reports and other information about you, including 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, creditors and other third parties. You also authorize GOLDENCAP to transmit this Application, along with any information obtained in connection with this Application, excluding consumer credit reports, to any or all of the Recipients.
42
Owner (1) Signature
Clear
43
Today's Date
Date
Month
Day
Year
44
Bank statement (1)Attach bank statement in PDF file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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45
Bank statement (2)Attach bank statement in PDF file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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46
Bank statement (3)Attach bank statement in PDF file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
Should be Empty: