GIP Funding Application

Enter basic information

Check your business's eligibility without impacting your credit.
Legal Business Name*
DBA Business Name
Optional
Your Name*

First NameLast Name
Mobile Phone Number*
Please enter a valid phone number.
Email*
example@example.com
I agree to receive texts via SMS under the terms below.
‍These messages may include informational updates such as appointment reminders, billing notifications, and updates related to your request. Message frequency may vary. Carriers are not liable for delayed or undelivered messages. Message and Data Rates: Standard message and data rates may apply, depending on your mobile carrier plan. Opt-Out: You can opt out of receiving text messages at any time by replying STOP to any message or contacting Lucid Diagnostics directly. After opting out, you may receive a final confirmation message. Help: For help, reply HELP to any message or contact our support team at 888-582-4339. Consent: Your consent to receive text messages is not a condition of any purchase. Privacy: We value your privacy. For more information on how we collect and use your data, please refer to our full Privacy Policy. By participating in our SMS/text messaging program, you agree to the terms outlined in this Privacy Policy.

Enter personal information

Check your business's eligibility without impacting your credit.
{yourName}
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Enter business information

Check your business's eligibility without impacting your credit.
{legalBusiness}
Same as home address
Business Address*

Business Address: Street

Street Address Line 2

CityState

Zip

Tell us about your business

Check your business's eligibility without impacting your credit.
{legalBusiness}
Legal Business Type*

Sole ProprietorshipLimited Liability CompanyCorporationPartnership
Industry Type
Industry type or SIC code
Date/Year Business Started*
Enter the month & year that this entity was formed
Date/Year Owned Since
Please enter the month and year since which you've owned this business
(Optional) Enter any current loan balances you have on this business
Please enter the name of your lender, the outstanding balance of any current loans on this business, and the date when the loan was originally funded. If you don't have any outstanding balances, leave this blank.
Monthly Gross Revenue*
Your estimated monthly revenue

Verify identity & ownership

Check your business's eligibility without impacting your credit.
Date of Birth*

MonthDayYear
Date
SSN*
Used for identity verification. This will not impact your credit score.
EIN (Tax ID Number)*
9 digits
I don't have an EIN number
Ownership Percentage*
Credit Score*
Enter your estimated credit score
Add a partner to this business?

Enter partner information

Check your business's eligibility without impacting your credit.
Partner Name

First NameLast Name
Ownership Percentage
Date of Birth

MonthDayYear
Date
SSN
Used for identity verification
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Please enter a valid phone number.

Upload bank statements

Check your business's eligibility without impacting your credit.
Please upload your business bank statements from the past three months.

Cancelof
Uploaded documents are protected with a bank-grade AES 256-bit SSL (Secure Socket Layer) connection that uses a SHA256 Certificate.

Last Step: Certify and agree to terms and conditions

Check your business's eligibility without impacting your credit.
Signature*

Clear
Date

MonthDayYear
Date
Partner Signature

Clear
Date

MonthDayYear
Date
utm_source
utm_campaign
rep
Should be Empty:

Enter basic information