PERSONAL INFORMATION
BUSINESS OWNER
*
First Name
Middle Initial
Last Name
Email
*
Business Phone
*
Cell Phone
*
Citizenship?
*
Please Select
US Citizen
Permanent Resident
Non-Permanent Resident
Social Security Number
*
DOB
*
-
Month
-
Day
Year
Date
Do You Own Or Rent?
*
Please Select
Own
Rent
BUSINESS INFORMATION
Company Name (Legal)
Website URL
*
Federal Tax ID/EIN
*
State Of Formation
*
Owner 2 Name (>20%)
Only fill out if different than business owner above
Owner 3 Name (>20%)
Only fill out if different than business owner above
Owner 4 Name (>20%)
Only fill out if different than business owner above
Average Monthly Revenue
*
Please Select
$30K or less
$31-$74K
$75-$149K
$150-$249K
$250-$499K
$500-$999K
$1M+
Time In Business
*
Industry
*
Describe Your Business
$ Amount Requested
*
What Are You Using the $ For?
*
Please Select
Expansion
Working Capital
Payroll
Purchase A Business
Purchase A Franchise
Equipment
Real Estate
Marketing
Buy Out A Partner
Start A Business
Consolidate Debt
Canna Business Financing (all verticals)
Please include documents requested during Discovery Call
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