BIANCO CAPITAL FUNDING

Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address
example@example.com
Business Legal Name/DBA*
EIN (TAX ID NUMBER)*
Business Start Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Industry*
How Much Money Are You Looking To Secure?*
Any Past or Current Bankruptcy's?*
Any Current Business Loan Balances?*
Ownership%*

SSN*
DOB*

MonthDayYear
Date
Credit Score*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What Is Most Important To You?
Attach The Following: Last 4 Months of Business Bank Statements, Drivers License, and Voided Check

Cancelof
By signing below, each of the above listed Business Owner(s)/Officer(s)Principal(s)/ and Business (individually and collectively "You") certify that all information and
documents submitted in connection with the Funding Application ("Application") are accurate, true, correct, and complete and that You will immediately notify BIANCO
Capital Funding LLC or any of it representatives, successors, assignees, agents, partners, or affiliates ("Recipients") of any change in such information or financial
condition. You acknowledge the Recipients are relying on information You provide. You further authorize BIANCO Capital Funding LLC and each of the Recipients that may
be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions
(collectively, "Transactions") to obtain consumer or personal, business and investigative reports and other information about You, including, but not limited to credit
card processor and bank statements from one or more consumer reporting agencies such as Transunion, Experian, and Equifax, and from other credit bureaus, banks,
financial institutions, creditors, and other third parties. You also authorize BIANCO Capital Funding LLC to transmit this Application along with any of the foregoing
information obtained in connection with this Application, to any or all the Recipients for the foregoing purposes.
Signature*

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