Loan Application Form
Desired Loan Amount $
Loan will be used for
New Business Funding
Working Capital
Equipment Funding
Investment Real Estate
Commercial Real Estate
Licensed Professional Loan
Other
Contact Information
Business Legal Name
Legal Entity
LLC
Corporation
Sole Prop.
Partnership
Business Start Date
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January
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Day
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Year
Monthly Business Revenue
$
Business Phone Number
-
Area Code
Phone Number
Owner
*
Title
First Name
Last Name
Website
Industry
Industry
Tax ID
Do you own or rent your location?
*
Own
Rent
Credit Score
*
Excellent (700+)
Good (650-700)
Fair (600-650)
Poor (
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
E-mail
*
example@example.com
Phone
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Drivers License
Browse Files
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of
Voided Bank Check
Browse Files
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of
Upload last 6 months of Business Bank Statements
Browse Files
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of
Comments
Consent
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 Merchant Capital Solutions (“Company”) 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 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.
YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
YES
Signature
Submit
Submit
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