Business Legal Name
*
Business DBA Name
Phone
*
Applicant Authorizes Harbor Hill Capital LLC to the use of SMS for promotional and follow up messages. You may opt-out by texting "STOP" to 86753. Message and data rates may apply. Text HELP for help" Message and data rates may apply.
Format: (000) 000-0000.
Email
*
Applicant Authorizes Harbor Hill Capital LLC to the use of email for promotional and follow up messages.
By checking this box, I agree to receive promotional and follow-up messages via SMS. This agreement isn't a condition of any purchase. Msg & Data rates may apply
By checking this box, you hereby consent to receive emails from Harbor Hill Capitol for the purpose of receiving updates, promotions, and important communications. You understand and acknowledge that your information will be handled in accordance with our Privacy Policy. You may unsubscribe at any time by using the 'Unsubscribe' link in our emails.
Street Address
*
City
*
State
*
Zip
*
Federal Tax ID (EIN)
*
Date Business Started
*
-
Month
-
Day
Year
Date
Product/Services sold
*
Legal Entity
Please Select
Partnership
Sole Prop
LLC
Corp
Other
Owner Information
Owner Name
*
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
SSN#
*
Date Of Birth
*
-
Month
-
Day
Year
Date
% Of Ownership
*
Credit Score (Approx.)
Home Street Address
*
City
*
State
*
Zip
*
Date
*
/
Month
/
Day
Year
Date
Do You Have any Current Positions?
Yes
No
Last 3 Month Bank Statements
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Current Positions
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Company Name
Balance
Position 1
Position 2
Position 3
Position 4
Owners Signature
By signing below, the Merchant and each of its owners/principals: (1) certify that all information and documents submitted in connection with this application are true, correct and complete; and (2) authorize "the Independent Sales Organization (“ISO”)" and its agents, partners, and outside funding partners to investigate Merchant’s and each of its owner’s/principal’s financial, business and personal credit histories, including by making soft or hard credit inquiries and obtaining and reviewing credit reports, and to obtaining other relevant information from other third parties, to verify any information provided with this application.
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