Client Application
Who is your Account Manager?
Client Information
What is your Legal Business Name?
DBA
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Federal Tax ID
Date Business Started
Type of Business / Industry
Type of Entity
Purpose of Loan/Advance
Marketing
Reduce Spending
New Location
Company Growth
Increase Sales
New Equipment
Are you current with your mortgage
Yes
No
Do you have any current tax liens?
Yes
No
Is your business seasonal?
Yes
No
Which of the following is the most important to you?
Lowest Payments (No matter the dollar amount or cost)
Highest Dollar Amount (No matter the cost or term)
Lowest cost (No matter the dollar amount or cost)
Best Sales Month
Request Amount
Gross Annual Sales
Owner / Partner Information
Name
First Name
Last Name
Social Security #
Personal Credit Score
Ownership Percentage
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Driver's License Number
Business Landlord or Mortgage Bank
Contact Name
Contact Number
Contact Email
Credit Card Processor Number
Company Debt Information
Current Cash Advance Company
Current Outstanding Balance
Funded Date
Repayment Schedule?
Daily
Weekly
Monthly
Funding Request
Consolidate
2nd position
3rd Position
Other
Preferred Terms
APPLICANT AUTHORIZES CAPITAL DEVELOPMENTS, LLC OR ITS ASSIGNS, AGENTS, BANKS, OR FINANCIAL INSTITUTIONS TO OBTAIN AN INVESTIGATIVE OR CONSUMER REPORT FROM A CREDIT BUREAU AND TO INVESTIGATE THE REFERENCES GIVEN OR ANY OTHER STATEMENTS OF DATA OBTAINED FROM APPLICANT AND TO ALLOW ITS LENDER OR FUNDER TO FILE APPROPRIATE UCC LIENS WHEN NECESSARY IN ORDER TO SECURE THE FUNDING.
Bank Statement (Last 3 months)
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Bank Statement
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Bank Statement
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Credit Report
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