BUSINESS FUNDING APPLICATION

Business Funding Application

California Finance Lender License # 60DBO-128093
Application Expiration

Due to the sensitive nature of the information contained, the application is set to expire at the time and date specified below. Please reach out to your account representative to obtain a new application link.
Lead First Name*
Lead Last Name*
ALT Lead Name
Lead Email
example@example.com
Lead Phone Number
Please enter a valid phone number.
COMPANY INFORMATION
Legal / Corporate Name*
Doing Business As
COMPANY ADDRESS
Company Address*
Company Address Suite
Company Address City*
Company Address State*
Company Address Zip Code*
MAILING/REGISTERED ADDRESS

IF DIFFERENT FROM PHYSICAL ADDRESS
Alt Company Address
Alt Company Address Suite
Alt Company Address City
Alt Company Address State
Alt Company Address Zip Code
Company Phone*
11-Digit Numbers Only! (18005551212)
Company Fax
Company Email*
example@example.com
Website Address
Business Start Date*

YearMonthDay
Date
Federal Tax ID / EIN*
State of Incorporation*
Company Type*
BUSINESS INFORMATION
What Business Industry Are You In?
Product or Service Sold / Description of Business*
Gross Monthly Revenue*
Numbers Only!
Gross Annual Revenue*
Numbers Only!
Avg Monthly Credit Card Revenue
Numbers Only!
Number of Owners*
How Much Funding Do You Need?*
Numbers Only!
Use / Purpose of Funding?*
Do You Have Any Open Loans or MCA Positions? If YES How Many:
Most Recent Funder's Name?
Most Recent Funder's Balance?
FINANCIAL STATEMENTS UPLOAD

Upload Most Recent Bank Statements. PDF Files Only!
Upload Bank Statement - Month 1

Cancelof
Upload Bank Statement - Month 2

Cancelof
Upload Bank Statement - Month 3

Cancelof
Upload Bank Statement - Month 4

*REQUIRED FOR CALIFORNIA COMPANIES
Cancelof
Upload Recent Credit Card Statement

Cancelof
OWNERSHIP INFORMATION - Applicant 1
Applicant 1 - First Name*
Applicant 1 - Last Name*
Applicant 1 - Home Address:*
Applicant 1 - Home Address: Line 2
Applicant 1 - Home Address: City*
Applicant 1 - Home Address: State*
Applicant 1 - Home Address: Zip Code*
Applicant 1 - Email Address*
example@example.com
Applicant 1 - Home Phone
Applicant 1 - Mobile Phone*
Applicant 1 - Company Title
Applicant 1 - FICO (Number Only!)*
Applicant 1 - Date of Birth*
Applicant 1 - Social Security No.*
Applicant 1 - Ownership Length*
Applicant 1 - Ownership %*
OWNERSHIP INFORMATION - Applicant 2
Applicant 2 - First Name
Applicant 2 - Last Name
Applicant 2 - Home Address:
Applicant 2 - Home Address: Line 2
Applicant 2 - Home Address: City
Applicant 2 - Home Address: State
Applicant 2 - Home Address: Zip Code
Applicant 2 - Email Address
example@example.com
Applicant 2 - Home Phone
Applicant 2 - Mobile Phone
Applicant 2 - Company Title
Applicant 2 - FICO (Numbers Only!)
Applicant 2 - Date of Birth
Applicant 2 - Social Security No.
Applicant 2 - Ownership Length
Applicant 2 - Ownership %
Applicant 1 Signature*

Clear
Date

MonthDayYear
Applicant 2 Signature

Clear
Date

MonthDayYear
By signing above, each of the above listed business and business owners/officers (individually and collectively, "you") authorize Montage Business Financial LLC ("MBF") and each of its representatives, successors, assigns, designees and third-party funding partners, which includes lenders and other finance providers with whom MBF has, or may in the future enter into, commercial-brokerage-financing relationships ("Recipients"): (1) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties; (2) to obtain the release, by any creditor or financial institution, of any information relating to any of you, to any Recipients; (3) to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all Recipients for the foregoing purposes; and (4) to contact you via e-mail, call and/or text-message at the e-mail address and/or phonenumber provided above, or at any e-mail address and/or phone number reasonably identified as belonging to you, including wireless numbers (if applicable), using an automated telephone dialing system or other similar system with respect to this application, future-related commercial-financing opportunities and/or other lawful telemarketing purposes (the consents provided in this subsection (4), the "Communications Consent" You hereby certify that all information and documents submitted in connection with this application are true, correct and complete.
CTID
MID
AR Name
Account Representative
Account Representative
CTUID
Broker Email
example@example.com
Broker Phone Number
MUID
Status
Should be Empty:

Business Funding Application

Application Expiration

COMPANY INFORMATION

COMPANY ADDRESS

MAILING/REGISTERED ADDRESS

BUSINESS INFORMATION

FINANCIAL STATEMENTS UPLOAD

OWNERSHIP INFORMATION - Applicant 1

OWNERSHIP INFORMATION - Applicant 2