Business Financing Application
Legal Business Name
*
DBA (if applicable)
State of Incorporation
*
Tax ID
*
Business Entity Type
*
Please Select
Corporation
Partnership
Sole Prop
LLC
Other
Industry
*
Business Phone Number
*
-
Area Code
Phone Number
Annual Gross Revenue
*
Business Start Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Loan Amount Requested
*
Use of Proceeds
*
Primary Business Owner
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
-
Area Code
Phone Number
Percent Ownership
*
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security #
*
Email
*
example@example.com
Annual Income
Secondary Owner
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
-
Area Code
Phone Number
Percent Ownership
Date of Birth
-
Month
-
Day
Year
Date
Social Security #
Email
example@example.com
Annual Income
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 Ardiaq Capital (“Ardiaq”) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Ardiaq of any change in such information or financial condition, (3) Applicant authorizes Ardiaq to share and disclose all information and documents that Ardiaq may obtain in connection with this application, including credit reports, to other persons or entities including third party lenders (collectively, "Assignees") 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) Ardiaq and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Ardiaq, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, including comprehensive business and personal credit histories or hard credit pulls, 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 Applicant. This authorization shall be valid for one hundred twenty (120) days unless revoked in writing by Applicant.
Primary Owner
*
Date Signed
*
-
Month
-
Day
Year
Date
Secondary Owner
Date Signed
-
Month
-
Day
Year
Date
Upload your last 3 months of business bank statements here
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