BUSINESS FUNDING APPLICATION
BUSINESS NAME
DBA
TAX ID NUMBER
Business Start Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MONTHLY REVENUE
OWNER INFOMATION
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CREDIT SCORE
SSN #
DATE OF BIRTH
OWNERSHIP %
By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted in connection with this Application is true, correct, and complete; and (2) authorize EJS Group LLC dba EJS Capital Group, and their representatives to receive/obtain credit reports and any other information regarding the Merchant and its owners and principals from third parties, and to verify any information provided on the Application.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: